Severe Bilateral Epithelial Hsv-Keratitis In A Healthy Young Woman
Published 2024
- 42nd Congress of the ESCRS
Reference: PO729
| Type: Poster
| DOI:
10.82333/w64d-ec89
Authors:
Pauline Scherm* 1
, Maurice Herr 1
, Wolfgang Mayer 1
1Department of Ophthalmology,LMU University Hospital,Munich,Germany
Purpose
Herpetic keratitis is one of the leading causes of corneal blindness worldwide. It typically occurs following reactivation of a latent infection with the herpes simplex virus (HSV) that can be differentiated by virus specific antigens into HSV-I and HSV-II. While around 90% of adults worldwide are either infected with HSV-1 or HSV-2, the incidence of epithelial HSV Keratitis is “only” around 1 million per year globally. Risk factors for reactivation of HSV infection include sunlight, fever, stress, or heat. While most of the infections appear unilaterally, epithelial HSV keratitis can rarely appear bilaterally, the incidence ranging between 1.3% and 10.9% in the literature.
Setting
Department of Ophthalmology, LMU University Hospital, LMU Munich, Germany
Methods
A 20-year-old female presented to our emergency department with bilateral eye pain, redness and photophobia in October 2023. Symptoms had initially started 5 days ago on the right and had proceeded 4 days ago onto the left eye. Upon request the patient stated having had fever and exhaustion a week ago. Other than that, her past medical history was unremarkable. Visual acuity without correction was 20/80 on the right, 20/125 on the left eye. Slit-lamp examination revealed subtarsal follicules, conjunctival injection as well as distinct branching epithelial dendrites with terminal bulbs that stained on fluorescein staining on both eyes. Corneal sensation was markedly decreased on both eyes.
Results
The patient was started on Acyclovir 30mg/g ointment every 4 hours, levofloxacin 5mg eye drops 4 times daily as well as lubrication bilaterally. On follow-up 3 days later the patient described improvement of symptoms. The branching epithelial dendrites had disappeared, both corneas showed pancorneal epithelial linear irregularities. Investigation for atopy or immunodeficiency via the general practitioner resulted unremarkable.
Conclusions
Cases of epithelial HSV keratitis only rarely present bilaterally. Reported risk factors include atopy as well as immunodeficiency as seen in patients with congenital immune deficiencies, HIV, cancer or status post organ transplant. Few cases of bilateral HSV keratitis occurring in immunocompetent patients exist in the literature. In our case, investigation for causes of immunodeficiency or atopy had been unremarkable. Nevertheless, the fever and exhaustion experienced a couple of days ahead might have been immunosuppressant enough to trigger reactivation of the HSV infection. A patient presenting with bilateral HSV keratitis should be checked for underlying causes, especially if the patient has no known record of previous diseases.