Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report
Abstract Background Herpes zoster ophthalmicus includes a wide spectrum of lesions at the ocular surface, including epithelial, stromal, endothelial keratitis, and uveitis. Thus far, the occurrence of corneal endothelial disorder in herpes zoster ophthalmicus and the causative virus have not been co...
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03319-5 |
| _version_ | 1818358381510918144 |
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| author | Seung Hyeun Lee Yeoun Sook Chun Kyoung Woo Kim |
| author_facet | Seung Hyeun Lee Yeoun Sook Chun Kyoung Woo Kim |
| author_sort | Seung Hyeun Lee |
| collection | DOAJ |
| description | Abstract Background Herpes zoster ophthalmicus includes a wide spectrum of lesions at the ocular surface, including epithelial, stromal, endothelial keratitis, and uveitis. Thus far, the occurrence of corneal endothelial disorder in herpes zoster ophthalmicus and the causative virus have not been confirmed, and the differential diagnosis and establishment of therapeutic strategies are challenging. Corneal endothelial coin-shaped lesions are well known to occur in cytomegalovirus-related corneal endotheliitis but have not been reported in patients with herpes zoster ophthalmicus. Case presentation A 39-year-old Asian female was referred to our ophthalmology department with recurrent anterior uveitis accompanied by coin-shaped corneal endothelial scar-like lesions that appeared after right facial herpes zoster. Diffuse corneal stromal haziness was mostly limited in the anterior stroma. The coin-shaped corneal endothelial lesions were separate from stromal lesions and showed a high-reflective scar-like line in sections of anterior segment optical coherence tomography. Anterior uveitis recurred each time she discontinued oral antiviral drug treatment for 12 months after the first event, but was remitted by the maintenance medications of combined topical ganciclovir gel with oral valaciclovir, at a dose lower than the usual adult dose, for acute or recurrent zoster-associated anterior uveitis. Corneal endothelial function remained normal and corneal endothelial and stromal lesions were unchanged throughout the treatment and follow-up period. Conclusions In patients with a history of facial herpes zoster with coin-shaped corneal endothelial scar accompanying recurrent anterior uveitis, suspicion for active varicella-zoster virus is warranted, and prolonged intake of oral antiviral agents is required despite varicella-zoster virus DNA not being detected in aqueous humor. |
| first_indexed | 2024-12-13T20:28:06Z |
| format | Article |
| id | doaj.art-efd0d40394184cbbb6c8247205892ad4 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-13T20:28:06Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-efd0d40394184cbbb6c8247205892ad42022-12-21T23:32:30ZengBMCJournal of Medical Case Reports1752-19472022-03-011611410.1186/s13256-022-03319-5Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case reportSeung Hyeun Lee0Yeoun Sook Chun1Kyoung Woo Kim2Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of MedicineDepartment of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of MedicineDepartment of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of MedicineAbstract Background Herpes zoster ophthalmicus includes a wide spectrum of lesions at the ocular surface, including epithelial, stromal, endothelial keratitis, and uveitis. Thus far, the occurrence of corneal endothelial disorder in herpes zoster ophthalmicus and the causative virus have not been confirmed, and the differential diagnosis and establishment of therapeutic strategies are challenging. Corneal endothelial coin-shaped lesions are well known to occur in cytomegalovirus-related corneal endotheliitis but have not been reported in patients with herpes zoster ophthalmicus. Case presentation A 39-year-old Asian female was referred to our ophthalmology department with recurrent anterior uveitis accompanied by coin-shaped corneal endothelial scar-like lesions that appeared after right facial herpes zoster. Diffuse corneal stromal haziness was mostly limited in the anterior stroma. The coin-shaped corneal endothelial lesions were separate from stromal lesions and showed a high-reflective scar-like line in sections of anterior segment optical coherence tomography. Anterior uveitis recurred each time she discontinued oral antiviral drug treatment for 12 months after the first event, but was remitted by the maintenance medications of combined topical ganciclovir gel with oral valaciclovir, at a dose lower than the usual adult dose, for acute or recurrent zoster-associated anterior uveitis. Corneal endothelial function remained normal and corneal endothelial and stromal lesions were unchanged throughout the treatment and follow-up period. Conclusions In patients with a history of facial herpes zoster with coin-shaped corneal endothelial scar accompanying recurrent anterior uveitis, suspicion for active varicella-zoster virus is warranted, and prolonged intake of oral antiviral agents is required despite varicella-zoster virus DNA not being detected in aqueous humor.https://doi.org/10.1186/s13256-022-03319-5Anterior uveitisCoin-shaped corneal endothelial scarFacial herpes zosterHerpes zoster ophthalmicusHerpes zoster virusRecurrence |
| spellingShingle | Seung Hyeun Lee Yeoun Sook Chun Kyoung Woo Kim Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report Journal of Medical Case Reports Anterior uveitis Coin-shaped corneal endothelial scar Facial herpes zoster Herpes zoster ophthalmicus Herpes zoster virus Recurrence |
| title | Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report |
| title_full | Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report |
| title_fullStr | Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report |
| title_full_unstemmed | Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report |
| title_short | Coin-shaped corneal endothelial scar in herpes zoster ophthalmicus: a case report |
| title_sort | coin shaped corneal endothelial scar in herpes zoster ophthalmicus a case report |
| topic | Anterior uveitis Coin-shaped corneal endothelial scar Facial herpes zoster Herpes zoster ophthalmicus Herpes zoster virus Recurrence |
| url | https://doi.org/10.1186/s13256-022-03319-5 |
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