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Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus.

Koji Toriyama1, Tomoyuki Inoue1, Takashi Suzuki1

  • 1Department of Ophthalmology, Ehime University School of Medicine, Toon, Japan.

Case Reports in Ophthalmology
|December 5, 2014
PubMed
Summary

Necrotizing keratitis caused by acyclovir-resistant herpes simplex virus (HSV) mimicked fungal infections, complicating treatment. Monitoring viral DNA load with PCR aided diagnosis and management of this resistant HSV case.

Keywords:
Acyclovir-resistant herpes simplex virusFungal infectionHerpes simplex virusNecrotizing keratitisReal-time polymerase chain reaction

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Area of Science:

  • Ophthalmology
  • Virology
  • Microbiology

Background:

  • Reports a case of necrotizing keratitis attributed to acyclovir-resistant herpes simplex virus (HSV).
  • The clinical presentation was notably similar to a prior fungal keratitis infection.
  • Highlights diagnostic challenges in distinguishing recurrent viral keratitis from other ocular infections.

Observation:

  • A patient with a history of herpetic keratitis developed necrotizing keratitis despite prior treatment.
  • Initial diagnosis suggested Candida albicans, but subsequent testing revealed herpes simplex virus type 1 (HSV-1).
  • Treatment with topical acyclovir (ACV) was ineffective, indicating acyclovir resistance.

Findings:

  • Penetrating keratoplasty was performed, revealing corneal abscess and erosion.
  • Polymerase chain reaction (PCR) initially negative for herpesviruses, later detected HSV-1 DNA.
  • Acyclovir (ACV) treatment failed to reduce HSV DNA load, confirming resistance.
  • Substitution with trifluorothymidine led to clinical improvement and decreased HSV DNA levels.

Implications:

  • Necrotizing keratitis can be caused by acyclovir-resistant HSV, presenting diagnostic challenges due to similar appearances to fungal keratitis.
  • Real-time PCR for monitoring herpes simplex virus (HSV) DNA load is crucial for managing refractory keratitis cases with atypical presentations.
  • This case underscores the importance of considering drug resistance in persistent or recurrent ocular infections.