A herpetic keratitis determined immunosuppressed patient with atypical presentation

Year 2019, Volume: 5 Issue: 1, 54 - 61, 29.03.2019

Mahmut Atum

Abstract

We
aimed to report a case of atypical herpetic keratitis that developed after
renal transplantation. A 48-year-old woman presented with redness, photophobia,
tearing, foreign body, sensation and decreased vision in the left eye. The
patient had undergone renal transplantation 6 months ago, was being treated by
systemic immunosuppressants. (Cyclosporine A, mycophenolate mofetil and
prednisolone acetate). Examination revealed Dellen ulcers and dendriform
lesions which were parallel to the limbus, extending from the temporal area
upper-quadrant to the nasal area. Based on the clinical findings, atypical
herpes simplex virus keratitis (HSVK) was suspected. The subsequent corneal
scraping and real-time polymerase chain reaction (PCR) analysis yielded a positive
result for Herpes Simplex Virus Type 1 (HSV-1) genome. Topical and systemic
acyclovir therapies were prescribed. One week later, the dendriform lesions
showed significant improvement and healed completely within 3 weeks. In
immunocompromised patients, herpetic keratitis can appear in unusual
presentations. Patient on immunosuppressive treatment with suspected herpetic
keratitis, early topical and systemic antiviral therapy may prevent permanent
vision loss and sequelae.

Keywords

Atypical herpetic keratitis, immunosuppression

References

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