Chronic Varicella-zoster Virus Epithelial Keratitis in Patients With Acquired Immunodeficiency Syndrome

Abstract

To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS).Methods: Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome.Results: Sixteen patients were studied. CD4 + Tlymphocyte cell counts were available in 11 patients, with a median of 0.034 ϫ 10 9 /L (range, 0-0.094 ϫ 10 9 /L ). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable. Conclusions:In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Course and complications of varicella zoster ophthalmicus in a high HIV seroprevalence population (Cape Town, South Africa)

“…Of these, nine were positive for VZV in epithelial dendrites. 13 Also of note in our population was that uveitis was still seen when the CD4 count was extremely low. The only patient with CD4o100 had a count of 48 and had uveitis.…”

Chronic mucocutaneous herpes simplex virus and varicella zoster virus infections

“…119 Unlike skin lesions, chronic VZV keratitis is very painful. 120 Neurologic disorders include longstanding active HSV encephalitis, 121 VZV-related chronic myelitis with chronic unilateral periauricular and facial pain, 122 active chronic VZV infection with chronic radicular sacraldistribution pain, cervical-distribution zoster paresis, and thoracic-distribution myelopathy, 123 chronic VZV ganglionitis-related postherpetic neuralgia, 124 and chronic HSV-2 meningitis. 125 TK-dependent antiviral resistance also frequently complicates extracutaneous HSV and VZV chronic infections.…”

Treatment of Pseudodendrites in Herpes Zoster Ophthalmicus With Topical Ganciclovir 0.15% Gel

“…As with systemic recurrences, the corneal lesions can also occur in both immunocompromised and immunocompetent states. [4][5][6] The finding of viral DNA in these lesions using polymerase chain reaction has established the underlying pathogenesis and role of antiviral therapy. 6,16 However, there is no consensus regarding the management; ophthalmologists often use different antivirals in varying combinations, dosages, and duration.…”

“…3 These ulcerations harbor viral DNA and warrant antiviral treatment to prevent further corneal damage. [4][5][6] Despite there being an increased understanding of the condition, there is no consensus regarding the treatment of these late corneal lesions in HZO. 4,5 Earlier, topical antiviral, trifluridine (TFT) 1% ophthalmic solution (Viroptic), had been used for these lesions with variable success.…”