Bilateral herpes simplex keratitis in a patient with chronic graft-versus-host disease

Case report

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Authors: Takahiko Hayashi, Misaki Ishioka, Norihiko Ito, Yoko Kato, Hisashi Nakagawa, et al

Published Date June 2008 Volume 2008:2(2) Pages 457 - 459

DOI: http://dx.doi.org/10.2147/OPTH.S1858

Takahiko Hayashi¹, Misaki Ishioka², Norihiko Ito¹, Yoko Kato¹, Hisashi Nakagawa³, Hiroshi Hatano⁴, Nobuhisa Mizuki¹

¹Department of Ophthalmology, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan; ²Ryogoku Eye Clinic, Tokyo, Japan; ³Tokushima Eye Clinic, Higashimurayama-shi, Tokyo, Japan; ⁴Lumine Hatano Eye Clinic, Fujisawa, Fujisawa-shi, Kanagawa, Japan

Purpose: To describe a case of bilateral herpes simplex keratitis accompanying chronic graft-versus-host disease (GVHD).

Design: Observational case report.

Case report: An 11-year-old boy with myelocytic leukemia underwent allogeneic bone marrow transplantation. He developed symptoms of the skin, eyes, and mouth, and lip biopsy indicated chronic GVHD. Persistent keratitis with corneal filaments and neovascularization was noted in both eyes. Sodium hyaluronate, autoserum, and 0.1% fluorometholone eyedrops were instilled for approximately 2 years to treat this keratitis, and there were no other ocular changes. Bilateral herpes simplex keratitis developed with geographic ulcers after topical betamethasone therapy, but responded to acyclovir ointment.

Conclusions: Herpes keratitis should be considered in the differential diagnosis of bilateral keratitis in patients with reduced immunocompetence. During the course of chronic GVHD, corneal herpes may occur, so ocular treatment with topical corticosteroids should be managed by an ophthalmologist to monitor sight-threatening conditions such as corneal herpes.

Keywords: chronic graft-versus-host disease, bone marrow transplant, corneal herpes, bilateral herpes simplex keratitis, dry eyes