Epidemic Keratoconjunctivitis-Associated Acute Dacryoadenitis in an Adult

A 39-year-old man presented with a five-day history of swelling of the right upper eyelid and ocular irritation in the right eye. On the first examination, the patient showed conjunctival injection, conjunctival chemosis, swollen upper eyelid, and palpable lacrimal gland with tenderness on the right side. Magnetic resonance images showed an inflamed right lacrimal gland. Blood test demonstrated negative results for immunoglobulin M of Epstein-Barr, mumps, herpes simplex, and herpes zoster viruses. We administered oral prednisolone (30 mg/day) based on a possible diagnosis of idiopathic dacryoadenitis. One week after steroid treatment, the periocular inflammation reduced to some extent although the inflammation substantially persisted. Four weeks after the steroid treatment, the patient informed us that he had met his friend 10 days before the onset, and that friend had conjunctival injection at that time which was subsequently diagnosed as an epidemic keratoconjunctivitis. The periocular inflammation subsided, but two corneal white spots were observed on slit-lamp examination. Although immunochromatographic test for adenovirus was negative, the blood test showed a positive result for immunoglobulin M of adenovirus serotype 3. In eight weeks of follow-up, the number of corneal opacities increased to five spots, but the acute dacryoadenitis did not recur.