%0 Journal Article
%T Bilateral herpetic keratitis presenting with unilateral neurotrophic keratitis in pemphigus foliaceus: a case report
%A Hee K Yang
%A Young K Han
%A Won R Wee
%A Jin H Lee
%A Ji W Kwon
%J Journal of Medical Case Reports
%D 2011
%I BioMed Central
%R 10.1186/1752-1947-5-328
%X A 71-year-old Korean man developed bilateral herpetic keratitis one week after rapid tapering of systemic corticosteroid. He had been on high-dose oral corticosteroid and azathioprine therapy for six months for treatment of pemphigus foliaceus. Topical acyclovir ointment was prescribed. A week later, our patient's right eye had healed, but his left eye showed increased stromal edema with enlarged epithelial defects. He was prescribed oral acyclovir with topical broad-spectrum antibiotics applied to his left eye. The stromal edema cleared within a week but the epithelial defect remained unchanged. An amniotic membrane transplantation was performed on our patient's left eye, and his epithelial defect had totally healed three weeks later.Patients with autoimmune disease or who are on immunosuppressive therapy have a higher chance of developing bilateral herpetic keratitis. Although rare, the condition may be followed by unilateral neurotrophic keratitis. Rapid corticosteroid tapering may act as a triggering factor for viral infection or reactivation of herpes.Herpes simplex keratitis is, in general, a unilateral disease, but bilateral occurrence has been reported in 1.3% to 10.9% of patients [1]. Bilateral herpetic keratitis is known to develop in patients with a compromised immune system, such as those with congenital immune deficiencies, atopy, long-term immunosuppression, or recipients of organ transplants [1-3].Pemphigus is a group of autoimmune skin diseases with recurrent formation of acantholysis and chronic bullae within the epidermis. Pemphigus foliaceus (PF) is a subtype with a relatively mild clinical course. Early signs include eczematous erythema of the skin and mucous membrane erosions. Ocular involvement is often reported, with the majority of these lesions confined to the conjunctiva (for example, pseudomembranous conjunctivitis), but the cornea is seldom involved [4]. Herpes simplex virus infection often occurs during the course of pemphigus, but herpe
%U http://www.jmedicalcasereports.com/content/5/1/328