Bilateral Encephalitozoon hellem Keratoconjunctivitis With Microsporidial Spores in Parrot Feces.

We describe bilateral Encephalitozoon hellem keratoconjunctivitis in a 39-year-old immunocompetent woman with two years of daily close contact with a pet parrot. She presented with a three-week history of bilateral ocular redness, itching, foreign-body sensation, and blurred vision that had not improved with topical fluorometholone, lubricants, and levofloxacin prescribed for presumed dry eye disease. Slit-lamp examination showed bilateral conjunctival inflammation and diffuse superficial punctate corneal infiltrates. Giemsa staining of a left-eye corneal scraping demonstrated oval spore-like structures, while bacterial and fungal cultures were negative. Metagenomic next-generation sequencing (mNGS) of the same specimen detected 9,684 reads assigned to E. hellem, with a relative abundance of approximately 98% and genome coverage of 63%, supporting the diagnosis. Fluorescence microscopy of a fecal specimen from the pet parrot revealed a small number of spore-like structures morphologically compatible with microsporidia, but no molecular typing was performed. The symptoms and corneal lesions resolved over six weeks during treatment with topical 0.02% polyhexamethylene biguanide, topical 0.5% gatifloxacin administered as post-scraping antibacterial prophylaxis, and a short course of oral albendazole, with no recurrence during four months of follow-up. This case highlights the diagnostic value of combining corneal-scraping microscopy with mNGS in treatment-refractory keratoconjunctivitis and the importance of obtaining a detailed avian-exposure history. It also illustrates that microscopic findings in avian feces alone cannot establish zoonotic transmission.