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Elvia Canseco, Janhavi Modak, Ashley Kingham, Venus Arevalo, Stella K. Kim; Bilateral Herpetic Keratoconjunctivitis in Cancer Patients. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6149.
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To describe bilateral herpetic keratoconjunctivitis in cancer patients from a tertiary hospital
IRB -aproved retrospective review of patients who were diagnosed with herpetic keratoconjunctivitis (both simplex and zoster) from June 2001-August 2011 at MD Anderson Cancer Center was conducted. Of them, bilateral cases were reviewed. Extensive literature search was performed on bilateral herpetic cases.
90 patients were diagnosed with herpetic simplex or zoster keratoconjunctivitis, of which 12 patients had bilateral disease (13.3%) with mean followup of 9.4 months (range 0.25 - 23). For the bilateral cases, the cancer diagnoses included leukemia (5), lymphoma/myeloma (5), breast (1) and colon cancer (1). 58% (7/12), 25% and 8% of patients had history of allogeneic stem cell transplantation (SCT), whole brain radiotherapy (XRT) including the orbits, and autologous SCT, respectively. 42% (5/12) patients were in remission from their cancer and 58% (7/12) were in active cancer treatment. Only 2 patients (16%) were not immunocompromised or suppressed (orbital XRT patients), but all others were either being actively treated for their relapsed cancer (with chemo/steroid) or immunosuppression after SCT (with tacrolimus/steroid). 58% (7/12) patients were on systemic steroids and 42% (5/12) were on prophylactic anti-viral medication at the time of presentation. 1 patient had disseminated herpetic disease and was on IV antiviral therapy. The diagnosis of herpetic disease was made clinically, and confirmatory rapid antigen immunofluorescence/or viral culture were positive in 10 cases (83.3%). Extensive literature search revealed bilateral cases of herpetic disease in atopic patients but none in cancer patient population.
Bilateral herpetic keratoconjunctivits in cancer patients is described. This study marks first in the literature to describe bilateral HSV and HZV keratoconjunctivitis in cancer patients. It was most frequently observed in patients on systemic steroid and immunocompromised patient population despite prophylaxis for herpetic disease. Further studies are needed to eluciate predisposing factors for bilateral disease in this patient population.
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