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First Author: N.Ziakas GREECE
Co Author(s): A. Karamitsos A. Chranioti P. Economidis
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Purpose: To report a case of bilateral Herpes Simplex Virus-1-related peripheral ulcerative keratitis (HSV-1-related PUK) leading to corneal perforation in a 24-year old man with primary Herpes Simplex Virus (HSV) infection.
11st Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
Results: Complete laboratory work-up, including infectious and autoimmune factors, revealed primary HSV infection. Bilateral positive PCR analysis of corneal scrapings for HSV verified initial end-organ infection. Progressive bilateral HSV-1 related PUK leading to bilateral superior corneal perforation with proptosis of the iris was managed by systemic acyclovir, topical acyclovir and prednisone, and bilateral surgical intervention. The patient underwent an eccentric penetrating keratoplasty in one eye, and a two-step procedure in the other; initially two corneal patch grafts and an amniotic membrane transplant were used, followed by a large-diameter penetrating keratoplasty one month later.
Conclusions: To the best of our knowledge this is the first case of bilateral HSV-1-related PUK in a patient with primary HSV infection ever described. In cases of PUK, differential diagnosis should include infectious and autoimmune diseases, as well as primary HSV as a pathogen, that may present with this form of keratitis, which if left untreated can possibly lead to devastating outcomes.