TOPICAL FUMAGILLIN IN THE TREATMENT OF MICROSPORIDIAL KERATOCONJUNCTIVITIS IN AIDS

OBJECTIVE: To report microsporidial keratoconjunctivitis in a patient infected with HIV who was treated with topical fumagillin. CASE SUMMAR Y: A 37-year-old white man who was experiencing redness, pain, irritat ion, decreased vision, and a foreign body sensation occurring in both eyes was referred to the ophthalmology clinic. The patient had a medic al history significant for AIDS, Pneumocystis carinii pneumonia, and C ytomegalovirus retinitis. Conjunctival smears were taken and stained p ositive for the presence of Microsporidia. The patient was diagnosed w ith bilateral microsporidial keratoconjunctivitis and fumagillin thera py was initiated. After 5 days of therapy, the patient reported signif icant improvements characterized by a decrease in blurred vision with only slight blurring in the left eye, decrease in headache, and decrea sed foreign body sensation. The patient continued topical fumagillin t herapy for more than 14 months with only slight blurring in the left e ye and no apparent ocular toxicity as a result of fumagillin therapy. DISCUSSION: Although rare in occurrence, increasing numbers of documen ted microsporidial infections are being reported in the medical litera ture, particularly in individuals who are seropositive for HIV. Clinic ians need to be cognizant of microsporidial keratoconjunctivitis as an other opportunistic infection in this patient population. CONCLUSIONS: Although a curative agent has yet to be discovered, fumagillin repres ents a safe, effective, low-cost, topical agent for the treatment of m icrosporidial keratoconjunctivitis.