Corneal Manifestations of Miltefosine Toxicity in Acanthamoeba Keratitis

A patient with acanthamoeba keratitis (AK) was prescribed miltefosine (hexadecylphosphocholine [HePC]) 50 mg twice daily to treat small stromal infiltrates that recurred with taper of medications (Fig A). Three weeks later new infiltrates were noted (Fig B). Miltefosine was increased to 3 times daily. After 2 weeks, dense stromal infiltrates developed (Fig C). Miltefosine toxicity was suspected. Miltefosine and hexamidine were discontinued, and...