Herpes simplex virus conjunctival dendritic ulcer as a primary infection in an immunocompetent patient

Abstract

AbstractPurposeTo describe an atypical case of conjunctival herpetic dendritic ulceration in an immunocompetent patient with no history of herpetic primary infection.MethodsThis is a single observational case report and a review of the literature. The patient was followed in successive appointments.ResultsOcular involvement by the herpes simplex virus (HSV) in its recurrent form is characteristic for dendritic ulcers in the corneal epithelium, which are postulated to obtain this form due to the corneal nerve plexus. We describe the first case to date of an immunocompetent patient, age > 70 years and without prior immunosuppressive treatment, with a primary herpetic infection clinically diagnosed by presenting a dendritic ulcer in the bulbar conjunctiva. The patient had nonspecific corneal involvement, and the case was subsequently confirmed with polymerase chain reaction for HSV‐1.ConclusionsThe presentation of a dendritic ulcer in the bulbar conjunctiva in a case of ocular herpes infection is a rare finding, and the physiopathology is unknown. It casts doubt on the theory that corneal dendritic ulcer morphology is only formed because of the corneal sub‐basal nerve plexus involvement. This suggests that conjunctiva examination is of vital importance in herpetic ocular infection, and that it can used a diagnostic methodology if no other eye conditions are found.