Concomitant Varicella Zoster Virus and Cytomegalovirus Corneal Endotheliitis in an Immunocompetent Patient

Abstract

ABSTRACT Purpose To describe an immunocompetent patient with corneal endotheliitis caused by concomitant infection of cytomegalovirus and varicella zoster virus (VZV). Case presentation A 37-year-old immunocompetent woman was referred to our hospital because of persistent corneal endotheliitis in the left eye. Slit-lamp examination revealed mild conjunctival injection, localized stromal corneal edema with underlying pigmented keratic precipitates, and inferior superficial corneal neovascularization. Anterior chamber examination revealed grade 2+ inflammatory cells. Real-time polymerase chain reaction analysis of aqueous humor supported a diagnosis of concomitant cytomegalovirus and VZV corneal endotheliitis. Treatment comprised oral valganciclovir and oral acyclovir for 6 weeks. During 12 months of follow-up, the cornea was clear, keratic precipitates were absent, and anterior chamber inflammation was resolved. No recurrences were noted. Conclusions Untreated corneal endotheliitis can cause corneal decompensation and permanent endothelial cell loss. Dual infection must be considered in patients with corneal endotheliitis, particularly those with inadequate treatment responses. Timely detection of causative agents and administration of an appropriate treatment regimen can prevent corneal damage.