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PHOTO ESSAY
Year : 2015  |  Volume : 63  |  Issue : 11  |  Page : 854-855

A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction


Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission29-Jul-2015
Date of Acceptance12-Oct-2015
Date of Web Publication16-Dec-2015

Correspondence Address:
Ankush Gondchawar
Govindnagar, Near Vidarbha Mill, Achalpur, Amaravati, Maharastra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.171968

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Keywords: Herpes simplex, polymerase chain reaction, uveitis


How to cite this article:
Gondchawar A, Biswas J, Murali S, Eawaran LM. A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction. Indian J Ophthalmol 2015;63:854-5

How to cite this URL:
Gondchawar A, Biswas J, Murali S, Eawaran LM. A case of herpes simplex keratouveitis diagnosed by real time polymerase chain reaction. Indian J Ophthalmol [serial online] 2015 [cited 2020 Jun 2];63:854-5. Available from: http://www.ijo.in/text.asp?2015/63/11/854/171968

A 59-year-old Asian Indian male presented with complaints of left eye blurring of vision associated with on and off episodes eye pain and redness since last 4 months. On examination, his best corrected visual acuity in the right eye was 6/15, N12 and left eye counting finger at 2 m, < N36. Anterior segment examination of the left eye revealed circumciliary congestion, corneal edema, mutton fat pigmented keratic precipitates, and dilated pupil with complicated cataract [Figure 1]a and b. Intraocular pressure (IOP) in the right eye was 18 and left eye 48 mmHg. On the basis of history and clinical examination, a probable diagnosis of viral anterior granulomatous keratouveitis was made. The patient was started on topical prednisolone, homatropine, and empirical tablet acyclovir. Patient was also advised tablet. Acetazolamide, topical antiglaucoma medications (timolol and brinzolamide) in left eye to control IOP. Anterior chamber tap was done in left eye for real time polymerase chain reaction (RT-PCR) for herpes simplex virus (HSV). RT-PCR report was positive for HSV [Figure 2]a and b. The patient was started with T. valacyclovir 1 g 3 times and tapering dose of topical prednisolone. The patient is on follow-up and responding well to the treatment.
Figure 1: Anterior segment photograph of the left eye showing large, pigmented keratic precipitates suggestive of granulomatous anterior uveitis in diffuse (white arrow) (a) and slit lamp illumination (white arrow) (b)

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Figure 2: (a) Real time polymerase chain reaction report showing exponential rise in viral DNA copies suggestive of active replication of herpes simplex I virus (blue arrow) along with positive control (red arrow) and (b) real time polymerase chain reaction report showing exponential rise of positive control only (yellow arrow) and not of herpes simplex II virus

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  Discussion Top


Human herpes virus affects various ocular tissues and is known to cause anterior and/or posterior uveitis. Uveitis in HSV ocular disease is usually associated with corneal stromal disease and often unilateral in nature. [1] Herpetic anterior uveitis is characterized by keratic precipitates, which can be of several forms such as fine diffuse, granulomatous, and nongranulomatous in appearance. It is often associated with iris atrophy, raised IOP, and dilated pupil in the absence of dilatation drops. [2],[3] Secondary glaucoma is also a common complication associated with herpetic uveitis. [3] PCR increases specificity and sensitivity of the detection of etiological agent from ocular fluids in a clinically suspected cases of herpetic uveitis and improves outcome of these diseases. [4],[5],[6] RT-PCR is a quick method for quantitative measurements of the viral load in RT, thus enabling detection of active replication of viruses.

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Santos C. Herpes simplex uveitis. Bol Asoc Med P R 2004;96:71-4, 77-83.  Back to cited text no. 1
    
2.
Van der Lelij A, Ooijman FM, Kijlstra A, Rothova A. Anterior uveitis with sectoral iris atrophy in the absence of keratitis: A distinct clinical entity among herpetic eye diseases. Ophthalmology 2000;107:1164-70.  Back to cited text no. 2
    
3.
Tugal-Tutkun I, Otük-Yasar B, Altinkurt E. Clinical features and prognosis of herpetic anterior uveitis: A retrospective study of 111 cases. Int Ophthalmol 2010;30:559-65.  Back to cited text no. 3
    
4.
Muccioli C, Lottenberg CL, Rizzo LV, Belfort Junior R. Real-time PCR in infectious uveitis as an alternative diagnosis. Arq Bras Oftalmol 2011;74:258-61.  Back to cited text no. 4
    
5.
Sugita S, Shimizu N, Watanabe K, Mizukami M, Morio T, Sugamoto Y, et al. Use of multiplex PCR and real-time PCR to detect human herpes virus genome in ocular fluids of patients with uveitis. Br J Ophthalmol 2008;92:928-32.  Back to cited text no. 5
    
6.
Tran TH, Rozenberg F, Cassoux N, Rao NA, LeHoang P, Bodaghi B. Polymerase chain reaction analysis of aqueous humour samples in necrotising retinitis. Br J Ophthalmol 2003;87:79-83.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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