Abstract
BackgroundWe evaluate the role of nerve growth factor (NGF) eye drops to treat a herpetic corneal ulcer resistant to systemic and local acyclovir treatment in an HIV-positive patient.Case PresentationA 68 year old HIV-positive male presented with a herpetic corneal ulcer which was treated unsuccessfully with acyclovir. Acyclovir sensitivity of herpes simplex virus was tested with a dye uptake assay and we found that the herpes simplex virus isolated was resistant to acyclovir. We started eye drop therapy with NGF and the corneal herpetic ulcer healed in 23 treatment days.ConclusionThe case presented here is the first described in the literature in which a herpetic corneal ulcer was successfully treated with NGF. We recommend that trials of NGF therapy in herpetic keratitis should be carried out on a larger number of acyclovir resistant cases.
Highlights
We evaluate the role of nerve growth factor (NGF) eye drops to treat a herpetic corneal ulcer resistant to systemic and local acyclovir treatment in an HIV-positive patient.Case Presentation: A 68 year old HIV-positive male presented with a herpetic corneal ulcer which was treated unsuccessfully with acyclovir
The case presented here is the first described in the literature in which a herpetic corneal ulcer was successfully treated with NGF
We recommend that trials of NGF therapy in herpetic keratitis should be carried out on a larger number of acyclovir resistant cases
Summary
This case illustrates the appearance of HSV-1 viral strains resistant to acyclovir [2]. Two mechanisms involve a deficiency of viral tk genes, the third shows drug resistance with normal expression of tk. These mutants have either an altered tk enzyme or a mutation in their DNA polymerase gene [7]. The mechanism of action of NGF on the ocular surface to heal corneal neurotrophic ulceration is not well defined. Http://www.jmedicalcasereports.com/content/1/1/124 reactivation is the consequence of the loss of balance between the cytokine produced by the corneal epithelial inflammation and the resulting reduction in the NGF-trkA complex signals [4]. 7. Andrei G, Snoeck R, De Clercq E, Esnouf R, Fiten P, Opdenakker G: Resistance of herpes simplex virus type 1 against different phosphonylmethoxyalkyl derivatives of purines and pyrimidines due to specific mutations in the viral DNA polymerase gene.
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