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M. Kandori, T. Inoue, II, Y. Hori, N. Maeda, Y. Tano; Varicella-zoster Virus Infection as a Cause of Atypical Extensive Pseudodendrites. Invest. Ophthalmol. Vis. Sci. 2007;48(13):344.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the cause of unknown keratitis with dendritic lesion and to report three cases of varicella-zoster virus (VZV) keratitis with atypical extensive pseudodendrite form.
Ten patients (6 males and 4 females) who revealed atypical keratitis with dendritic lesion were included in this study. Clinical examination and detection with polymerase chain reaction (PCR) for Herpes simplex virus (HSV), VZV, Cytomegalovirus (CMV) or acanthamoeba (AA)-DNA against their corneal epithelium were performed for these patients.
HSV-DNA was detected in four patients and VZV-DNA in three. CMV-DNA or AA-DNA was not detected. No detection was revealed in other three cases. Specifically, three cases detected VZV revealed extensive pseudodendrites that is atypical VZV keratitis. These VZV patients were 2 males and 1 female. Case1 (a 55-year-old man) had severe scleritis and keratitis with extensive pseudodendrites in the left eye. Case2 (a 57-year-old woman) had keratouveitis and sizable dendrites in the left eye. Case3 (59-year-old man with lattice corneal dystrophy type IIIA) had keratouveitis with large pseudodendrites in his left eye. Pseudodendrites were progressed geographic keratitis after the use of steroid agent. After PCR detection of VZV-DNA, they received systemic and localized antiviral therapy. These three cases were complicated with scleritis or uveitis, therefore had the history of steroid treatment. They were resistant for treatment with sole acyclovir ointment, but developed better with more strong medications combined local acyclovir ointment with systemic valaciclovir.
Although typical VZV pseudodendrites were reported to be relatively small, these three cases complicated atypical extensive VZV pseudodendrites. PCR detection from their debribed corneal epithelium declared VZV to be the cause of atypical sizable dendritic lesion. VZV keratitis should be included in the differential diagnosis of unknown keratitis with extensive dendritic lesion.
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