Isolated herpes simplex keratoconjunctivitis in a neonate born by cesarean delivery

Herpes simplex virus (HSV) infection can be devastating in the neonate. The disease most commonly presents as 1 of 3 clinical manifestations: disseminated visceral infection (with and without central nervous system involvement), isolated meningoencephalitis, and infection limited to the skin, eyes, and/or mucous membranes (SEM). Exposure leading to neonatal infection typically occurs as peripartum vertical transmission, most typically by direct contact with urogenital lesions or infected genital secretions, or as an ascending infection exploiting disrupted chorioamniotic membranes. We present a novel case of a newborn girl who developed HSV-2 keratoconjunctivitis despite being delivered via an elective, uncomplicated, repeat cesarean over intact chorioamniotic membranes in the absence of active clinical maternal HSV infection and despite having a negative medical history of previous orolabial or genital herpetic infection.