UNUSUAL HERPES: A DIFFERENT KIND OF PRESENTATION

Herpes simplex infection is ubiquitous in humans; at autopsy, nearly 100% of persons older than 60 years are found to harbor HSV. It has been estimated that one-third of the world population experiences recurrent infection. HSV infections are, therefore, a large and worldwide public health problem. The main purpose of our work is to enphasize this problem, and to alert Ophthalmologists that there are some kinds of a not so typical presentation, which we all must be aware.

Instituto de Oftalmologia Dr. Gama Pinto (IOGP)

Case report from one of our patients with a primary ocular HSV infection with an unusual form of presentation.

Case report: Male, 35 years. At the first clinical appointment, the patient reffered on the right eye a foreign-body sensation, light sensivity, redness, and blurred vision. The patient had no significant past medical history. Visual acuity of 10/10 (by the Snellen acuity chart) in each eye. Intraocular Pressure of 13/12 mmHg in each eye. At observation, the patient presented vesicles on the skin near the right eye, a fibrovascular proliferation (the unusual form of presentation we would like to point out and show) from the conjunctiva to the Cornea and, with fluoresceíne staining of the right eye, dendritic epithelial keratitis. There were no alterations at the ocular fundus. With the diagnosis of primary ocular HSV infection in mind, the patient started topical Valganciclovir and ocular lubrication. About 3 days later, the epithelial keratitis was already resolved, the fibrovascular proliferation was recceding, and one week later, it was already gone.

HSV infections are very prevalent, and, as Ophthalmologists, we must all be aware of ocular manifestations, as there are many (to periocular vesicles to dendritic epithelial keratitis). Sometimes, some unusual forms may appear (as the one we described), and we must stay alert to this, so we can treat the patients on time, and in the best possible way.