KERATOCONJUNCTIVITIS IN A PATIENT WITH MONKEYPOX INFECTION.

To report a case of keratoconjunctivitis secondary to Monkeypox infection in an immunocompetent patient.

A 37-year-old male patient presented with left-eye conjunctival erythema, photophobia, pain and mucoid discharge for the past week. He had returned from a trip to the United States, coinciding with the onset of symptoms. The patient did not present fever or skin lesions. He had no contacts with infectious symptoms. Not vaccinated for smallpox.

Visual acuity (VA) in the left eye was 20/40. Ophthalmologic examination revealed left eye conjunctivitis, limbitis, keratitis, two corneal ulcers, mucoid discharge, and conjunctival membranes.

Empirical therapy was started with ophthalmic drops of ofloxacin and Ciprofloxacin ointment, which were replaced 48 hours later due to poor evolution for reinforced Vancomycin and Ceftazidime eye drop every other our and oral Ciprofloxacin twice a day. Polymerase chain reaction (PCR) for Sexually Transmitted Diseases and serology for HIV were performed, which were negative.

Two days after, the patient presented a maculopapular skin lesion of approximately 8 mm from the external canthus of the left eye and reported a lesion with similar characteristics on the dorsum of the left hand, which resolved spontaneously.

The patient was examined by expert dermatologists, which indicated a high suspicion of Monkeypox infection, so PCR was performed on the skin lesions and the conjunctival secretion, both of which were positive.

Nine days after, the skin lesions had disappeared and the patient had no systemic symptoms, but he continued with keratitis and a larger corneal ulcer, in addition to blepharoconjunctivitis and an increase in pain and photophobia symptoms, VA at that time was counting fingers, for which the administration of oral Valganciclovir 450 mg twice a day was started, topical Acyclovir 5 times a day, Ofloxacin eye drops 4 times a day, Dexamethasone eye drops 3 times a day, insulin eye drops 3 times a day and artificial tears 6 times a day, resulting in re-epithelialization of the corneal ulcer, resolution of conjunctivitis and limbitis and improvement of blepharitis.

The conjunctival secretion PCR for Monkeypox was repeated one month after the initial PCR, which was negative.

He currently presents a best corrected visual acuity (BCVA) of 20/30, with leukoma in the area of ​​the corneal ulcer.

Keratonjunctivitis associated with monkeypox might present before skin lesions, solve after them and may be a way of transmitting the disease.

The current outbreak highlights the need for healthcare providers to be familiar with the identification of monkeypox, to ensure strict infection control measures are implemented and timely treatment provided. 

Research is needed to optimise treatment strategies and allow development of guidelines for clinical management and therapeutics.