Abstract
Purpose:To present a case of bilateral peripheral ulcerative keratitis (PUK) caused by primary herpes simplex virus-1 (HSV-1) infection resulting in corneal perforation.Case Report:A 24-year-old man presented at the eye casualty of our clinic, with a 20-day history of severe pain, redness, photophobia, and tearing in both of his eyes. Slit-lamp examination revealed bilateral superior corneal perforation. A laboratory work-up that included immunological testing for infectious and autoimmune factors showed primary HSV infection. Positive PCR analysis of corneal scrapings for HSV confirmed initial end-organ ocular infection. Because the patient showed progressive HSV-1-related PUK resulting in bilateral superior corneal perforation with iris prolapse, he was prescribed both systemic and topical acyclovir and prednisone. He then underwent bilateral surgical intervention, namely eccentric penetrating keratoplasty in one eye and a two step procedure in the other, whereby two corneal patch grafts and an amniotic membrane transplant were initially used, followed 1 month later by a large diameter penetrating keratoplasty.Conclusion:In cases of PUK, differential diagnosis should include infectious and autoimmune diseases. Primary HSV should also be considered as a potential cause of this form of keratitis, which, if left untreated, can lead to devastating outcomes. To our knowledge, this is the first published case of bilateral PUK caused by primary HSV-1 infection.
Highlights
We describe a rare case of primary herpes simplex virus‐1 (HSV‐1) infection with ocular manifestations that led to bilateral corneal perforation
Physical examination and laboratory work‐up excluded the involvement of any other organ, while the ocular involvement was verified by Herpes simplex virus (HSV) antigen polymerase chain reaction (PCR) analysis of corneal scrapings
Diagnosis was confirmed by HSV antigen PCR analysis in two cases and by transmission electron microscopy in one case.[11,12]
Summary
Herpes simplex virus (HSV) causes a wide variety of ocular diseases, because HSV can infect a. Bilateral herpes simplex virus‐related peripheral ulcerative keratitis leading to corneal perforation in a patient with primary herpes simplex virus infection. A 24‐year‐old man presented at the eye casualty of our clinic, with a 20‐day history of severe pain, redness, photophobia, and tearing in both of his eyes He had been treated repeatedly with corticosteroids and prophylactic topical antibiotics for bilateral viral conjunctivitis. Slit‐lamp examination revealed acute conjunctival hyperemia and inflammation, bilateral superior corneal perforation, and peripheral subepithelial and stromal neovascularization extending to the margins of the perforation and causing sizable iris prolapse was noted. Both anterior chambers were shallow [Figures 1 and 2].
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