Viral Keratitis Masquerading As Immune Reaction Post Blood Transfusion

To report a case of viral keratitis masquerading as immune reaction post blood transfusion.

In outpatient settings. The patient is a known case of deep vein thrombosis and was on antiplatelets. the patient received a blood transfusion post antiplatelet abuse, following which he developed eye complications.

A young male presented to our outpatient department with sudden diminution of vision in both eyes, 3 days post blood transfusion. The patient was a known case of Deep vein thrombosis and was on anti-platelets for the same. Patient had an accidental antiplatelet drug abuse and needed an urgent blood transfusion. Post blood transfusion patient developed sudden diminution of vision in both eyes. The Snellen’s visual acuity in both eyes was 3/60 and 6/60 in Right eye (OD) and Left eye (OS), respectively. The IOP in both eyes was 24 and 22mmHg in OD and OS, respectively. On SLP, both eyes had  epithelial microcystic edema along with stromal edema and enlarged endothelial cells. Both eyes has cells and flare reaction. A probable diagnosis of acute immune mediated inflammation post blood transfusion was made. The patient was started on topical steroids, cycloplegics, anti-glaucoma and antibiotic eye drops. Blood investigations was ordered before planning for oral steroids (to rule out any infectious cause). At one week follow up, corneal edema improved with slight improvement in vision of both eyes. On SLP, OD demonstrated a PUK like lesion and OS showed a dendritic lesion,challenging the previous diagnosis. The treatment was modified, and antiviral therapy started with topical antivirals and oral antivirals drugs. The topical steroids were stopped. The PUK healed up in OD along with disappearance of dendritic lesion in OS. The visual acuity improved further to 6/12 in both eyes.

Viral infections can present as a wide spectrum ,in various forms- can be dendritic, geographical, stromal , endothelitis  and can even masquerade as severe  immune reaction in body.This case highlights that viral keratitis can masquerade as a severe immune response also. A keen eye and regular follow up helps in making an accurate diagnosis and in managing these cases.