Treatment of Acyclovir‐Resistant Herpes Simplex Virus Keratitis in a Patient with Wiskott‐Aldrich Syndrome

Pratuangtham, Surasak; Bornstein, Scott M.; Boyer, Kenneth M.; McAuley, James B.; Deutsch, Thomas A.; Gotoff, Samuel P.

doi:10.1086/516968

Cited by 5 publications

(2 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This includes one article that reported two cases of proven acyclovir-resistant herpetic keratitis and one suspected case of herpetic keratitis that were unresponsive to topical and oral acyclovir/valacyclovir and subsequently required intravenous foscarnet 5. A further two articles, one by Pratuangtham et al, reported the case of a patient with Wiskott–Aldrich syndrome who developed cutaneous and corneal herpetic infections that were resistant to acyclovir (intravenous acyclovir 30 mg/kg), also requiring intravenous foscarnet 6. The second article, being a case report by Bodaghi et al, reported the case of a 31-year-old female with AIDS who developed bilateral dendritic corneal ulcers associated with severe disciform keratitis that was unresponsive to acyclovir treatment (800 mg 5 times a day; topical 5 times a day) and subsequently required intravenous foscarnet 7.…”

Section: Discussionmentioning

confidence: 99%

Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

Turner¹,

Beckingsale²

2013

OPTH

View full text Add to dashboard Cite

PurposeTo report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluridine.MethodsA case of a 35-year-old female with herpetic epithelial keratitis resistant to acyclovir is described. The patient presented following treatment for 4 weeks with topical acyclovir ointment five times per day and oral valacyclovir 1 g three times per day for herpetic keratitis with no resolution of the epithelial defect or symptoms. Corneal scrapes and swabs were taken for confirmation of the diagnosis and resistance testing. The results were positive for herpes simplex virus 1 and showed acyclovir resistance (inhibitor concentration 90 = 200 μg/mL) and foscarnet sensitivity (inhibitor concentration 90 = 200 μg/mL). The patient was treated with topical trifluridine 2-hourly for 3 weeks and weaned off the drops over the following week.ResultsThe patient showed resolution of the epithelial defect, but did have significant corneal toxicity associated with the use of the trifluridine. At 8 weeks, the patient had some stromal shadowing associated with the recent active infection, but symptoms had settled.ConclusionThis case documents the effective use of topical trifluridine in proven acyclovir-resistant herpetic keratitis. It highlights three things: (1) the importance of considering topical trifluridine as an alternative to topical acyclovir in unresponsive disease; (2) the need to consider solid-organ transplant recipients in the immunocompromised population with resistant herpetic disease, and (3) the need to look for alternatives to treatment of resistant herpetic disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

Turner¹,

Beckingsale²

2013

OPTH

View full text Add to dashboard Cite

show abstract

“…It has been shown to be effective in both HIV patients and bone marrow transplant recipients and is currently the recommended treatment for non‐ocular aciclovir‐resistant HSV disease 19 . Intravenous foscarnet for aciclovir‐resistant keratitis has been reported in an HIV‐positive patient (CD4 count 120/mm 3 ) with a mutation in the HSV TK gene and also in a patient with Wiskott–Aldrich syndrome 20 . As there is an intrinsic rate of aciclovir resistance in immunocompetent patients there are likely to be further cases in this population, and intravenous foscarnet is an important therapy to consider.…”

Section: Discussionmentioning

confidence: 99%