When One Virus Is Not Enough : Hsv-1 / Cmv Coinfection In Infantile Keratitis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR102 | Type: Case Report | DOI: 10.82333/0fdf-qa33
Authors: Dr Lina Mkhairi* 1 , A/Prof. hassan moutei 1 , A/Prof. fouad chraibi 1 , A/Prof. meriem abdellaoui 1 , A/Prof. idriss benatiya andaloussi 1
1ophtalmology,hassan 2 chu teaching hospital, Omar Idrissi Hospital,fes,Morocco
Purpose
The purpose is to report a rare case of an infected viral keratitis in early infancy resulting of a simultaneous HSV-1 and CMV coinfection, and to highlight the importance of considering viral coinfection in severe or atypical presentations.
Setting
Ophthalmology Department, tertiary care hospital.
Report of case
A 3-month-old infant, born anonymously with unknown maternal and family history, was admitted for an infectious keratitis of presumed viral origin complicated by a bacterial infection. She presented with a 15-day history of unilateral red eye associated with photophobia and a lower eyelid erythema, with reported worsening following topical corticosteroid use.
Ocular examination of the left eye revealed a blepharospasm, a lower eyelid erythema, an epiphora, and a purulent discharge.
Slit-lamp examination showed conjunctival hyperemia, a central geographic corneal ulcer measuring 4 × 3 mm that stains with fluoresceine with irregular, raised and infiltrated borders. The anterior chamber was deep and quiet, and the intraocular pressure was normal. Fundus examination was not feasible; ocular ultrasound was unremarkable. The slit lamp exam of the other eye was normal.
Corneal and conjunctival cultures grew methicillin-sensitive Staphylococcus aureus confirming the microbial infection. Polymerase chain reaction (PCR) testing confirmed viral coinfection with HSV-1 and CMV.
The patient was treated with oral antiviral therapy (10 mg/kg) combined with topical ciprofloxacin, resulting in rapid clinical improvement and resolution of the corneal abscess.
To our knowledge, and in the litterature, no other case of coinfection HSV-1/CMV responsible of an infectious keratitis has been described.
Conclusion/Take home message
Viral coinfection may occur in cases of infectious keratitis, particularly in severe or atypical presentations. Early recognition of viral involvement and prompt initiation of appropriate therapy are essential to prevent irreversible corneal damage and long-term visual impairment, especially in infants.