Microsporidial keratoconjunctivitis may mimic allergy

Molecular testing identified Encephalitozoon hellem in a 9-year-old orthokeratology lens wearer after conventional treatment failed.

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A 9-year-old girl with persistent keratoconjunctivitis was diagnosed with microsporidial keratoconjunctivitis after failing allergy treatment.
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In vivo confocal microscopy and anterior segment optical coherence tomography provided diagnostic insights but could not directly identify microsporidia.
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Metagenomic next-generation sequencing confirmed the diagnosis of microsporidial keratoconjunctivitis by identifying E hellem.
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The patient improved significantly with targeted therapy, achieving 20/20 visual acuity and resolution of symptoms by day 14.
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The case highlights the need to consider microsporidial infection in patients with unresponsive keratoconjunctivitis, especially with lens wear.

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