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Herpetic epithelial keratitis caused by acyclovir-resistant strain

Y Mori1, Y Inoue, Y Shimomura

  • 1Department of Ophthalmology, Osaka University Medical School, Suita, Japan.

Japanese Journal of Ophthalmology
|January 1, 1994
PubMed
Summary

Acyclovir-resistant herpes simplex virus caused recurrent keratitis in a patient. Long-term oral acyclovir and steroids led to resistance, highlighting careful treatment considerations for herpetic eye disease.

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Area of Science:

  • Ophthalmology
  • Virology
  • Pharmacology

Background:

  • Herpetic keratitis is a common cause of corneal blindness.
  • Recurrent herpetic keratitis can lead to vision loss.
  • Acyclovir is a standard antiviral treatment for herpes simplex virus infections.

Observation:

  • A 60-year-old man developed dendritic keratitis during long-term oral acyclovir therapy.
  • The patient experienced recurrent herpetic keratitis, initially treated with oral ACV and steroid eyedrops.
  • Acyclovir-resistant herpes simplex virus (HSV) was identified in vitro.

Findings:

  • Dendritic keratitis emerged despite oral acyclovir treatment.
  • The isolated virus demonstrated in vitro resistance to acyclovir (ED50 = 4.4 μg/ml).

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  • The dendritic lesion healed spontaneously after reducing steroid dosage.

    • Implications:

    • This case underscores the potential for acyclovir resistance in herpes simplex virus infections.
    • Careful consideration of acyclovir administration route, duration, and concomitant steroid use is crucial.
    • Monitoring for antiviral resistance may be necessary in refractory or recurrent cases of herpetic keratitis.