CASE REPORT: HERPETIC NECROTIZING STROMAL KERATITIS

Herpes simplex virus (HSV) is one of the most frequent cause of corneal ulcer and blindness in the end. Patients with ocular HSV infection and with oder systemic diseases, such is for example sarcoidosis in our case presentation, and additionally compromised with COVID-19 infection, is real challenge in our everyday practice. The purpose of our case presentation is to share our experience and difficulties that we faced with our patient.

Patient, female, year of birth: 1950, came to our hospital with pain and blurred vision in the right eye and with photophobia. Other diseases: diabetes mellitus typ 2, insulin therapy, hypertensio arterialis on medication, and sarcoidosis. VOD: sc 3/50, VOS: sc 1.0, TOU: dig N. Slit lamp exam: conjunctiva hyperemic, cornea central punctate defects, fluorescein staining, edema of cornea. Serology on HSV IgG positive, HZV IgG positive, CMV IgG positive, HbA1c 12%. In treatment we gave local therapy, antibiotics, lubricants eye drops, oral Hernovir 400 mg 4x1, periocular injection of triamcinolon acetate, and we have preformed a surgery amniotic membrane transplantation. After few days, patient felt better and local status of the right eye was improved. After few months patient came back with exacerbation of the symptoms, she had COVID-19 infection and after few weeks she felt pain in the right eye, and had red right eye. VOD: HM, TOD: dig N+1, slit lamp examination: conjunctiva hyperemic, corneal neovascularization. cornea central ulcer, fluorescein staining, stromal necrosis, 

As ophthalmologist we must struggle every day with complications of systemic diseases and their effect on eyes. Even when we do our best to cure and save patients eyes, imunne system is crucial for patients health in general. COVID-19 infection have several complications on patients body, some of them we have already noticed, but we consider that most of them is still unknown. It is very important that we have systematic approach to complicated cases.