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Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1.
Cornea 2019; 38(9):1185-1188C

Abstract

PURPOSE

To report a case of severe bilateral necrotizing herpes simplex keratitis (HSK) in an immunocompetent patient, with genotyping of the underlying herpes simplex virus 1 (HSV-1).

METHODS

Genetic analyses of HSV-1 in tear samples were performed with polymerase chain reaction-based restriction fragment length polymorphism, targeting the viral genes unique short (US)2, US4 (glycoprotein G), and US7 (glycoprotein I).

RESULTS

A 64-year-old woman with no history of atopy or immune disorders manifested bilateral keratitis with geographic ulcer. Her initial visual acuity was 20/1000 (OD) and 20/20 (OS). Polymerase chain reaction testing of a tear sample revealed the presence of HSV-1 in both eyes, and the patient was diagnosed with bilateral HSK. Both eyes progressed to necrotizing keratitis during the treatment course. Continuous intensive treatment, at first with acyclovir ointment and oral valacyclovir and later with steroid eye drops for stromal keratitis, finally improved the patient's condition. However, after 2 years, her visual acuity was limited to 20/250 (OD) and 20/60 (OS) because of corneal opacity from scarring. We found that the strain in the current case had a genotype combination of C/A/B (for US2/US4/US7), a known pattern in Japan, in both eyes.

CONCLUSIONS

We successfully performed an unprecedented genetic analysis of an HSV-1 strain isolated from a case of bilateral necrotizing HSK in an immunocompetent patient. The association of the HSV-1 genotype with the clinical manifestation remains unclear, calling for more data from new cases, especially from different geographic regions.

Authors+Show Affiliations

Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.Departments of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan.Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan. Collaborative Program for Ophthalmic Drug Discovery, Tohoku University Graduate School of Medicine, Sendai, Japan. Departments of Retinal Disease Control, Tohoku University Graduate School of Medicine, Sendai, Japan. Department of Advanced Ophthalmic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. Department of Ophthalmic Imaging and Information Analytics, Tohoku University Graduate School of Medicine, Sendai, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31205162

Citation

Yoshida, Masaaki, et al. "Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1." Cornea, vol. 38, no. 9, 2019, pp. 1185-1188.
Yoshida M, Hosogai M, Yokokura S, et al. Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1. Cornea. 2019;38(9):1185-1188.
Yoshida, M., Hosogai, M., Yokokura, S., Sato, K., Hariya, T., Kobayashi, W., ... Nakazawa, T. (2019). Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1. Cornea, 38(9), pp. 1185-1188. doi:10.1097/ICO.0000000000002026.
Yoshida M, et al. Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1. Cornea. 2019;38(9):1185-1188. PubMed PMID: 31205162.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bilateral Necrotizing Herpes Simplex Keratitis in an Immunocompetent Patient With Genetic Analysis of Herpes Simplex Virus 1. AU - Yoshida,Masaaki, AU - Hosogai,Mayumi, AU - Yokokura,Shunji, AU - Sato,Kota, AU - Hariya,Takehiro, AU - Kobayashi,Wataru, AU - Okabe,Tatsu, AU - Todokoro,Daisuke, AU - Nakazawa,Toru, PY - 2019/6/18/pubmed PY - 2019/6/18/medline PY - 2019/6/18/entrez SP - 1185 EP - 1188 JF - Cornea JO - Cornea VL - 38 IS - 9 N2 - PURPOSE: To report a case of severe bilateral necrotizing herpes simplex keratitis (HSK) in an immunocompetent patient, with genotyping of the underlying herpes simplex virus 1 (HSV-1). METHODS: Genetic analyses of HSV-1 in tear samples were performed with polymerase chain reaction-based restriction fragment length polymorphism, targeting the viral genes unique short (US)2, US4 (glycoprotein G), and US7 (glycoprotein I). RESULTS: A 64-year-old woman with no history of atopy or immune disorders manifested bilateral keratitis with geographic ulcer. Her initial visual acuity was 20/1000 (OD) and 20/20 (OS). Polymerase chain reaction testing of a tear sample revealed the presence of HSV-1 in both eyes, and the patient was diagnosed with bilateral HSK. Both eyes progressed to necrotizing keratitis during the treatment course. Continuous intensive treatment, at first with acyclovir ointment and oral valacyclovir and later with steroid eye drops for stromal keratitis, finally improved the patient's condition. However, after 2 years, her visual acuity was limited to 20/250 (OD) and 20/60 (OS) because of corneal opacity from scarring. We found that the strain in the current case had a genotype combination of C/A/B (for US2/US4/US7), a known pattern in Japan, in both eyes. CONCLUSIONS: We successfully performed an unprecedented genetic analysis of an HSV-1 strain isolated from a case of bilateral necrotizing HSK in an immunocompetent patient. The association of the HSV-1 genotype with the clinical manifestation remains unclear, calling for more data from new cases, especially from different geographic regions. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/31205162/Bilateral_Necrotizing_Herpes_Simplex_Keratitis_in_an_Immunocompetent_Patient_With_Genetic_Analysis_of_Human_Simplex_Virus_1 L2 - http://Insights.ovid.com/pubmed?pmid=31205162 DB - PRIME DP - Unbound Medicine ER -