Bilateral Herpes Simplex Keratitis Presenting as Peripheral Ulcerative Keratitis

Praidou, Anna; Androudi, Sofia; Kanonidou, Evgenia; Konidaris, Vasileios; Alexandridis, Alexandros; Brazitikos, Periklis

doi:10.1097/ico.0b013e31822f3c18

Cited by 22 publications

(16 citation statements)

References 15 publications

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“…A recent study has reported that the levels of inflammatory factors, such as G-CSF, TNF-α, IL-6, and IP-10, are significantly higher in severely ill COVID-19 patients than those in less severely ill patients, indicating that cytokine surge is involved in the pathogenesis of the disease [12]. In infectious immune corneal injuries, bilateral peripheral ulcerative keratitis caused by the herpes simplex virus [19] and bilateral disciform keratitis complicated by adenoviral conjunctivitis [20] due to the induction of inflammatory reactions or immunological responses in the corneal stroma by immune-degrading complexes have also been reported. However, these delayed corneal infiltrations display different clinical signs, and therefore, they are often misdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

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Relapsing viral keratoconjunctivitis in COVID-19: a case report

Guo

Xia

Wang

et al. 2020

Virol J

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Background: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, many studies have reported the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the conjunctival sac of patients infected with this virus, with several patients displaying symptoms of viral conjunctivitis. However, to our best knowledge, there is no in-depth report on the course of patients with COVID-19 complicated by relapsing viral conjunctivitis or keratoconjunctivitis. Case presentation: A 53-year-old man confirmed with COVID-19 developed symptoms of viral conjunctivitis in the left eye approximately 10 days after the onset of COVID-19. The results of a nucleic acid test were positive for SARS-CoV-2 in the conjunctival sac of the left eye. The symptoms were relieved 6 days after treatment. However, the patient was subsequently diagnosed with viral keratoconjunctivitis in both eyes 5 days after the symptoms in the left eye were satisfactorily relieved. The disease progressed rapidly, with spot staining observed at the periphery of the corneal epithelium. Although SARS-CoV-2 could not be detected in conjunctival secretions, the levels of inflammatory factors, such as interleukin-6, were increased in both eyes. Both eyes were treated with glucocorticoids, and symptoms were controlled within 5 days. There was no recurrence. Conclusions: In this case report, the pathogenesis, clinical manifestations, treatment, and outcome of a case with COVID-19 complicated by relapsing viral keratoconjunctivitis is described, and the involvement of topical cytokine surge in the pathogenesis of COVID-19 as it relates to viral keratoconjunctivitis is reported.

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Section: Discussionmentioning

confidence: 99%

“…Since the outbreak of Coronavirus Disease 2019 (COVID- 19) in December 2019, the number of infections and deaths has increased exponentially. At the time of this writing, more than 2 million people have been infected with SARS-CoV-2 worldwide [1].…”

Section: Introductionmentioning

confidence: 99%

Relapsing viral keratoconjunctivitis in COVID-19: a case report

Guo

Xia

Wang

et al. 2020

Virol J

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“…it is characteristically unilateral. 1 Bilateral herpetic keratitis is particularly rare, with a reported incidence of 1% to 10%. [2][3][4] Bilateral involvement may be noted in patients with atopy, measles, graft-versus-host disease, immunodeficiency, and in younger patients.…”

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confidence: 99%

Bilateral Herpetic Keratitis in Atopic Dermatitis

Maeno

Koh

2019

Mayo Clinic Proceedings

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26-year-old man with a history of atopic dermatitis presented with redness, lacrimation, and photopsia in both eyes, especially the right eye (Figure A), for 1 month. Visual acuity was 20/20 in the right eye and 20/25 in the left eye. Slitlamp examination with fluorescein dye revealed conjunctival hyperemia and dendritic corneal epithelial ulcer with terminal bulbs, findings that are consistent with herpes simplex keratitis (Figure B). Dendritic corneal ulcer is the most common subtype of herpes simplex keratitis;

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“…12,13 In some cases, the DNA HSV isolation by PCR has been the only microbiological test that supported the diagnosis of stromal necrosis due to herpetic infection. 14 Other authors suggest that a combination of at least two laboratory tests, such as PCR for HSV-1 DNA, Giemsa stain for multinucleated giant cells, or immunofluorescence assay (IFA) for HSV-1 antigen, could be required to confirm the diagnosis in atypical cases of HSV keratitis. 15 Finally, the invasive but definitive methods to diagnose the infective cause of the stromal lysis in these RA patients would be the immunohistopathology of the corneal biopsy, 16 as was described in 1 of the 2 cases reported by Zaher; electron microscopy was performed and showed clusters of typical herpes virus particle within almost all of the keratocytes.…”

Section: Discussionmentioning

confidence: 99%

“…18 Bilateral HSK is very rarely reported in the literature and bilateral herpetic keratitis presenting as PUK is considered an even rarer manifestation of herpetic disease. 14 The recurrence of some form of ocular HSV occurred in 2 of 5 patients (40%) during follow-up, both having recurrences even during the prophylactic oral regimen considered standard for immunocompetent patients, [19][20][21] one as the typical geographic ulcer pattern after penetrant keratoplasty and the other as stromal necrotizing with positive PCR. Case 2 experienced recurrence with famciclovir 250 mg/day but stopped at 750 mg/day.…”

Section: Discussionmentioning

confidence: 99%