Bilateral Herpetic Keratitis in a Patient with Pemphigus Foliaceus

ABSTRACT

PURPOSE: To report a case of bilateral herpetic keratitis in a patient during glucocorticoid treatment of pemphigus foliaceus. METHODS: A 71-year-old man presented with pain and epiphora in both eyes for a week. He had a history of pemphigus foliaceus for a 6-month period and was on glucocorticoid treatment. Anterior segment examination showed conjunctival injection and corneal geographic epithelial defects in both eyes. He was diagnosed with herpetic keratitis and was given a topical antiviral ointment. RESULTS: One week after the initial antiviral treatment, the corneal epithelial defect of the right eye had fully improved, whereas the left eye showed increased stromal edema with enlarged epithelial defects. Oral antiviral agents were given with topical broad spectrum antibiotics, and artificial tears added for the left eye. A week later, the stromal edema of the left eye had decreased but the epithelial defect was stationary. Amniotic membrane transplantation was performed on the left eye. The corneal epithelial defects of the left eye healed remarkably. CONCLUSIONS: Herpetic keratitis is, in general, a unilateral disease. Bilateral herpetic keratitis is much rarer, and has been described mostly in patients with an altered immune system. The disease progress is known to be similar in both eyes in most cases of bilateral herpetic keratitis, whereas in this case, the fellow eye showed delayed healing. Amniotic membrane transplantation seems to be an effective treatment modality on persistent epithelial defect due to herpetic keratitis.