Steroid-responsive unilateral keratouveitis following systemic treatment in a patient with human immunodeficiency virus and leishmaniasis

Ocular leishmaniasis, a rare form of vector-borne parasitic infection, can affect the adnexa, retina, uvea, and cornea. Coinfection with human immunodeficiency virus (HIV) and Leishmania may be a distinct clinical entity as the pathogens act synergistically, enhancing each other's pathogenicity, and leading to more severe forms of the disease. Ocular leishmaniasis in the setting of HIV coinfection most commonly causes anterior granulomatous uveitis, for which the etiology can be either active ocular infection or posttreatment inflammatory phenomenon. Keratitis is not considered to be associated with HIV but has rarely been seen from direct parasite invasion or in association with miltefosine. The judicious use of steroids in the treatment of ocular leishmaniasis is critical as steroid use is paramount to the treatment of uveitis associated with posttreatment inflammatory phenomenon but can worsen the prognosis when given in the setting of active, untreated infection. Here, we present a case of unilateral keratouveitis in a leishmaniasis and HIV-coinfected male following completion of systemic antileishmanial therapy. The keratouveitis completely resolved with only the addition of topical steroids. The rapid resolution with steroids suggests that keratitis, not only uveitis, can be an immune-mediated phenomenon in post- or ongoing-treatment individuals.