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Cytomegalovirus Induced Infectious Crystalline Keratopathy After Penetrating Keratoplasty
Mehrnaz Atighehchian1,2, Zahra Jafari1, Siamak Zarei-Ghanavati3
1Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Purpose:
To report a rare case of post-penetrating keratoplasty infectious crystalline keratopathy caused by Cytomegalovirus (CMV).
Methods:
The patient's history, clinical presentation, laboratory, and imaging analysis were reviewed.
Results:
A 55-year-old male patient was referred to our hospital with a medical history of 3 prior penetrating keratoplasty procedures because of post-refractive surgery infectious keratitis and epithelial downgrowth. He has been on both systemic and topical immunosuppressive medications. The patient presented with decreased vision, and on examination, a needle-like branching corneal lesions was identified, consistent with the diagnosis of infectious crystalline keratopathy. After negative results from smear and culture of corneal samples, molecular evaluation using polymerase chain reaction testing revealed the presence of CMV. Consequently, immunosuppressive therapy was adjusted, and systemic and topical antiviral treatments were initiated, resulting in a favorable clinical response.
Conclusions:
This case emphasizes the importance of considering CMV infection in progressive and nonresponsive infectious crystalline keratopathy to antimicrobial medications, particularly in immunosuppressed individuals. In addition, polymerase chain reaction is an appropriate laboratory molecular diagnostic test for the accurate diagnosis of CMV keratitis.
Insights
A rare case of Cytomegalovirus (CMV) causing infectious crystalline keratopathy after corneal transplant is reported. Polymerase chain reaction confirmed CMV, leading to adjusted immunosuppression and antiviral treatment for a positive outcome.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Microbiology
Background:
- Infectious crystalline keratopathy (ICK) is a rare corneal disease.
- Cytomegalovirus (CMV) keratitis can occur post-keratoplasty, especially in immunosuppressed patients.
- Diagnosis of ICK can be challenging, often requiring advanced molecular techniques.
Purpose of the Study:
- To present a rare case of post-penetrating keratoplasty ICK caused by CMV.
- To highlight the diagnostic challenges and management of such cases.
- To emphasize the role of molecular diagnostics in identifying the causative agent.
Main Methods:
- Case report review including patient history, clinical presentation, and diagnostic workup.
- Corneal sample analysis including smear, culture, and polymerase chain reaction (PCR) for pathogen identification.
- Review of treatment strategies and clinical outcomes.
Main Results:
- A 55-year-old male with a history of multiple corneal transplants presented with decreased vision and needle-like corneal lesions suggestive of ICK.
- Standard corneal cultures were negative, but PCR testing confirmed the presence of CMV.
- The patient showed a favorable clinical response after adjusting immunosuppressive therapy and initiating antiviral treatment.
Conclusions:
- CMV should be considered in cases of progressive or unresponsive ICK, particularly in immunosuppressed individuals.
- PCR testing is a valuable tool for the accurate and timely diagnosis of CMV keratitis.
- Prompt diagnosis and appropriate management, including antiviral therapy, are crucial for favorable outcomes in CMV-related corneal infections.
