{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:40:02Z","timestamp":1781059202145,"version":"3.54.1"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2015,3,27]]},"abstract":"<jats:p>A 48-year-old woman who is a contact lens wearer presented with unilateral <jats:italic>ACANTHAMOEBA<\/jats:italic> keratitis, confirmed by PCR, which responded initially to topical polyhexamethylene biguanide (PHMB) and brolene. Three months later, despite continued treatment, she developed diffuse anterior scleritis with severe pain and marked scleral injection but without evidence of recurrence keratitis. Oral non-steroidal anti-inflammatories and oral high-dose corticosteroids were added without success. Subsequent treatment with intravenous methylprednisolone and high-dose cyclosporine led to a temporary improvement. Re-presenting with signs of recurrent scleritis and severe pain, the antitumor necrosis factor monoclonal antibody adalimumab, and later oral cyclophosphamide, were added. This led to complete quiescence of the scleritis. Unfortunately, frequent recurrences of <jats:italic>ACANTHAMOEBA<\/jats:italic> keratitis and anterior uveitis occurred on immunosuppression requiring continued treatment with PHMB, brolene and topical corticosteroids. This is the first case of severe refractory <jats:italic>ACANTHAMOEBA<\/jats:italic> scleritis requiring the concomitant use of four immunosuppressive agents to achieve continued disease control. The challenges in managing this case are discussed.<\/jats:p>","DOI":"10.1136\/bcr-2014-208536","type":"journal-article","created":{"date-parts":[[2015,4,15]],"date-time":"2015-04-15T10:01:22Z","timestamp":1429092082000},"page":"bcr2014208536","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Use of multiple immunosuppressive agents in recalcitrant <i>ACANTHAMOEBA<\/i> scleritis"],"prefix":"10.1136","volume":"2015","author":[{"given":"Estera","family":"Igras","sequence":"first","affiliation":[{"name":"Ophthalmology Department, Royal Victoria Eye and Ear Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Murphy","sequence":"additional","affiliation":[{"name":"Ophthalmology Department, Royal Victoria Eye and Ear Hospital, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,4,15]]},"reference":[{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.310.6994.1567"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.2","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.1986.01050210067027"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9394(14)70007-8"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(02)01039-4"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.5","doi-asserted-by":"publisher","DOI":"10.1097\/ICO.0b013e31812e61e4"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.6","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.ajo.2009.06.009","article-title":"Acanthamoeba keratitis: diagnosis and treatment update 2009","volume":"1484","author":"Dart","year":"2009","journal-title":"Am J Ophthalmol"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2011.03.019"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.8","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00173-09"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00436-007-0858-3"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00436-014-3932-7"},{"key":"2025082722340862000_2015.apr15_1.bcr2014208536.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-008-0955-8"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2014-208536","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:34:17Z","timestamp":1756359257000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2014-208536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4,15]]},"references-count":11,"alternative-id":["10.1136\/bcr-2014-208536"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2014-208536","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,4,15]]}}}