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GI intolerance and lack of efficacy during treatment of keratoconjunctivitis: case report An 18-year-old woman developed GI intolerance during treatment with doxycycline for infectious keratoconjunctivitis. Additionally, she exhibited lack of efficacy during treatment with erythromycin for infectious keratoconjunctivitis [dosages and duration of treatment to reaction onset not stated]. The woman was referred with keratoconjunctivitis of the left eye. One month prior to current presentation, she had visited a local ophthalmologist with 2 days of left eye discomfort, redness and blurry vision. At the time, she had been diagnosed with keratoconjunctivitis due to possible exposure to debris from a bird cage. She was treated with ofloxacin. The following day, she visited a local corneal specialist and oral doxycycline was added to her treatment. A conjunctival swab specimen for presence of Chlamydia trachomatis, mycoplasma and viral cultures was taken. Within days, she developed GI intolerance related to doxycycline treatment. Therefore, the woman’s doxycycline therapy was switched to oral erythromycin. Over the following month, due to lack of response to erythromycin she was treated with prednisolone acetate. Her Chlamydia trachomatis, mycoplasma and viral cultures returned negative. With taper of prednisolone acetate her symptoms worsened. Therefore, she was referred to current centre for further evaluation and management. After thorough evaluation, she was presumed to have Chlamydia psittaci keratoconjunctivitis. She was treated with off-label topical 1% azithromycin two times daily for 2 days, then once daily for 5 weeks, along with loteprednol etabonate [loteprednol]. A PCR and serology testing for Chlamydia psittaci was negative. After 6 weeks, clinical improvement was noted. Test of the affected conjunctival swab was positive for Encephalitozoon hellem, which was confirmed by PCR testing. She elected definitive topical antifungal and anti-microsporidial treatment with a 3 week course of off-label topical 1% voriconazole six times daily without taper. There was resolution of all signs and symptoms, except for residual subepithelial epithelial nummular infiltrates. [outcome of ADR not stated]. Ma KK, et al. Dual Molecular Diagnosis of Microsporidia (Encephalitozoon hellem) Keratoconjunctivitis in an Immunocompetent Adult. Cornea : 19 Aug 2020. Available 803505441 from: URL: http://doi.org/10.1097/ICO.0000000000002466

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Reactions 10 Oct 2020 No. 1825