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Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus.
Case Rep Ophthalmol 2014; 5(3):325-8CR

Abstract

BACKGROUND

We report a case of necrotizing keratitis caused by acyclovir (ACV)-resistant herpes simplex virus (HSV) with a clinical appearance similar to a previous fungal keratitis infection.

METHODS

Observational case report.

RESULTS

Penetrating keratoplasty was performed in the left eye with a history of herpetic keratitis that resolved with periodic treatment with ACV ointment and a topical steroid. The left eye was painful and red with an abscess and corneal erosion in the peripheral donor cornea. Examination of the scraped corneal epithelium by light microscopy and culturing identified Candida albicans; polymerase chain reaction (PCR) was negative for human herpes viruses. After antifungal treatment, the ocular pain gradually decreased and the lesions slowly improved but recurred with a similar clinical appearance. A second light microscopy examination and cultures were negative for pathogens including C. albicans. PCR was positive for HSV-1 DNA; treatment with 3% topical ACV ointment was unsuccessful. A third examination showed only HSV-1 DNA. Despite antiviral ACV ointment, no clinical improvement occurred based on the HSV DNA copy numbers, which were the same before and after treatment, indicating a possible ACV-resistant strain. When topical trifluorothymidine was substituted for ACV, clinical improvement occurred and the HSV DNA copy numbers decreased.

CONCLUSION

Necrotizing keratitis induced by ACV-resistant HSV occurred independently after fungal keratitis, with a similar clinical appearance in this case, making diagnosis and treatment difficult. Monitoring the HSV DNA load by real-time PCR could be useful for refractory cases even with atypical clinical appearances.

Authors+Show Affiliations

Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

25473399

Citation

Toriyama, Koji, et al. "Necrotizing Keratitis Caused By Acyclovir-resistant Herpes Simplex Virus." Case Reports in Ophthalmology, vol. 5, no. 3, 2014, pp. 325-8.
Toriyama K, Inoue T, Suzuki T, et al. Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus. Case Rep Ophthalmol. 2014;5(3):325-8.
Toriyama, K., Inoue, T., Suzuki, T., Kobayashi, T., & Ohashi, Y. (2014). Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus. Case Reports in Ophthalmology, 5(3), pp. 325-8. doi:10.1159/000368297.
Toriyama K, et al. Necrotizing Keratitis Caused By Acyclovir-resistant Herpes Simplex Virus. Case Rep Ophthalmol. 2014;5(3):325-8. PubMed PMID: 25473399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus. AU - Toriyama,Koji, AU - Inoue,Tomoyuki, AU - Suzuki,Takashi, AU - Kobayashi,Takeshi, AU - Ohashi,Yuichi, Y1 - 2014/10/10/ PY - 2014/12/5/entrez PY - 2014/12/5/pubmed PY - 2014/12/5/medline KW - Acyclovir-resistant herpes simplex virus KW - Fungal infection KW - Herpes simplex virus KW - Necrotizing keratitis KW - Real-time polymerase chain reaction SP - 325 EP - 8 JF - Case reports in ophthalmology JO - Case Rep Ophthalmol VL - 5 IS - 3 N2 - BACKGROUND: We report a case of necrotizing keratitis caused by acyclovir (ACV)-resistant herpes simplex virus (HSV) with a clinical appearance similar to a previous fungal keratitis infection. METHODS: Observational case report. RESULTS: Penetrating keratoplasty was performed in the left eye with a history of herpetic keratitis that resolved with periodic treatment with ACV ointment and a topical steroid. The left eye was painful and red with an abscess and corneal erosion in the peripheral donor cornea. Examination of the scraped corneal epithelium by light microscopy and culturing identified Candida albicans; polymerase chain reaction (PCR) was negative for human herpes viruses. After antifungal treatment, the ocular pain gradually decreased and the lesions slowly improved but recurred with a similar clinical appearance. A second light microscopy examination and cultures were negative for pathogens including C. albicans. PCR was positive for HSV-1 DNA; treatment with 3% topical ACV ointment was unsuccessful. A third examination showed only HSV-1 DNA. Despite antiviral ACV ointment, no clinical improvement occurred based on the HSV DNA copy numbers, which were the same before and after treatment, indicating a possible ACV-resistant strain. When topical trifluorothymidine was substituted for ACV, clinical improvement occurred and the HSV DNA copy numbers decreased. CONCLUSION: Necrotizing keratitis induced by ACV-resistant HSV occurred independently after fungal keratitis, with a similar clinical appearance in this case, making diagnosis and treatment difficult. Monitoring the HSV DNA load by real-time PCR could be useful for refractory cases even with atypical clinical appearances. SN - 1663-2699 UR - https://www.unboundmedicine.com/medline/citation/25473399/Necrotizing_keratitis_caused_by_acyclovir_resistant_herpes_simplex_virus_ L2 - https://www.karger.com?DOI=10.1159/000368297 DB - PRIME DP - Unbound Medicine ER -