tailieunhanh - Báo cáo y học: "Bilateral herpetic keratitis presenting with unilateral neurotrophic keratitis in pemphigus foliaceus: a case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Bilateral herpetic keratitis presenting with unilateral neurotrophic keratitis in pemphigus foliaceus: a case report. | Yang et al. Journal of Medical Case Reports 2011 5 328 http content 5 1 328 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Bilateral herpetic keratitis presenting with unilateral neurotrophic keratitis in pemphigus foliaceus a case report Hee K Yang1 Young K Han2 Won R Wee1 Jin H Lee1 and Ji W Kwon3 Abstract Introduction We report a case of bilateral herpetic keratitis developing after rapid oral corticosteroid tapering in a patient with pemphigus foliaceus which was followed by unilateral neurotrophic keratitis that was treated with amniotic membrane transplantation. Case presentation 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. Conclusions 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. Introduction Herpes simplex keratitis is in general a unilateral disease but bilateral occurrence has been reported in to of patients 1 . Bilateral herpetic keratitis is known to develop in patients with a compromised immune system such as those with congenital immune .