Epithelial Dendritic Keratitis, Crescent Stromal Infiltrates And Endothelial Keratitis As A Manifestation Of Monkeypox (Mpox) Corneal Infection In A Great Mimicry Of Herpetic Keratitis - A Case Report

To report a case of Monkey Pox keratitis that is resembling herpetic keratitis in a young adult. 

The patient presented to emergency department at King Kjaled Eye Specialist Hospital, Riyadh, Saudi Arabia, in 2023

A case-report of a 26 year-old-lady who presented to emergency department with redness, photophobia and rop in vision in the left eye. The onset of symptoms was 4 days prior to presintation. the patient was diagnosed with systemic MonkeyPox (MPOX) infection 2 weeks prior, after she developed skin rash and fever. The left eye exam was significant for moderate conjunctival injection, central corneal epithelial dendrites surruounded by two crecentric superficial stromal infiltrates (Figure 1), the underlying cornea was edematous with a disciform endothelitis and keratic precipitates

The patient was initially diagnosed with herpetic keratitis and herpetic PCR was obtained, treatment with topical Ganciclovir gel and systemic Acyclovir was started. on a follow up visit four days later, the epithelial dendrites progressed to geographic depects and the crecentring infiltrates became larger (Figure 2), herpetic PCR was negative, another PCR for MPOX was obtained and was positive. Topical interferone alpha 2b and Cidofovir drops were started, the patient significantly improved, epithelial defect healed and corneal infeltrates decresed in size, topical steroide were then addedd and the corneal edema and endothelitis dramatically impoved (Figure 3).

Monkey Pox Keratitis -although rare- can present with very similar findings as herpetic keratitis. Proper patient evaluation and identification is important as our case didn't respond to the standared anti-herpetic medications and needed further anti-viral and immunologic compounded drops. Further reports and studies will help to reach standdard protocols for treatment of such cases.