Anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis associated with herpes zoster

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Abstract

AIM: To analyze etiopathogenesis, clinical features, and a treatment algorithm for acute anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis in order to increase medical awareness of herpes zoster in children.

RESULTS: Long-term exposure to rapid temperature changes contributed to varicella-zoster virus (VZV) reactivation in a child leading to herpes zoster rarely occurring in children, onset of anterior diffuse scleritis and hypopyon anterior uveitis. Corticosteroid therapy without causal treatment led to herpes virus reactivation in the patient’s cornea which contributed to herpes corneal ulcer.

CONCLUSION: Etiopathogenesis features were analyzed, characteristic clinical symptoms of anterior diffuse scleritis, herpes corneal ulcer, and hypopyon anterior uveitis caused by varicella-zoster virus (VZV) reactivation were described. Reactivation led to herpes zoster with skin eruption and herpes zoster ophthalmicus, such as injury of the ophthalmic branch of the trigeminal nerve without extraocular (skin) symptoms of herpes infection. The VZV etiological role was established based on high titers of anti-VZV IgG antibodies, the presence of anti-VZV-gE IgG antibodies (markers of active viral replication), and the efficacy of anti-herpes therapy. The described clinical symptoms of combined ophthalmic pathology contribute to the early diagnosis of ocular herpes for timely antiviral herpes therapy to prevent chronic disease and complications and to preserve and/or recover visual acuity.

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About the authors

Lyudmila A. Kovaleva

Helmholtz National Medical Research Center of Eye Diseases; Russian University of Medicine

Author for correspondence.
Email: ulcer.64@mail.ru
ORCID iD: 0000-0001-6239-9553
SPIN-code: 1406-5609

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow; Moscow

Natalya V. Balatskaya

Helmholtz National Medical Research Center of Eye Diseases

Email: balnat07@rambler.ru
ORCID iD: 0000-0001-8007-6643
SPIN-code: 4912-5709

Cand. Sci. (Biology)

Russian Federation, Moscow

Galina I. Krichevskaya

Helmholtz National Medical Research Center of Eye Diseases

Email: gkri@yandex.ru
ORCID iD: 0000-0001-7052-3294
SPIN-code: 6808-0922

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Albina A. Baisangurova

Helmholtz National Medical Research Center of Eye Diseases

Email: alia-bai-5@mail.ru
ORCID iD: 0000-0002-8014-667X
SPIN-code: 2308-0920

MD, Ophthalmologist

Russian Federation, Moscow

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2. Fig. 1. Diffuse scleritis: a — diffuse edema and purple bulbar hyperemia on the sclera, at 3 o’clock in the utmost right position of gaze, the lower boundary of the evenly penetrating scleral infiltrate is 6 mm in diameter; b — the upper boundary of the evenly penetrating scleral infiltrate is 6 mm in diameter in the upper temporal quadrant of the sclera, in the utmost down-right position of gaze

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3. Fig. 2. Marginal map-like corneal ulcer: а — marginal map-like translucent ulcer-infiltrate (3 × 4 mm) in the paralimbal cornea, at 2 to 4 o’clock reaching deep stromal layers, with fluorescein staining, b — cobalt filter; marginal corneal ulcer (3x4 mm) reaching deep stromal layers, with fluorescein staining

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4. Fig. 3. Active hypopyon anterior uveitis: 1.5 mm hypopion in anterior chamber aqueous humor, fibrin membrane on the anterior lens capsule

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