一名佩戴隐形眼镜者出现非典型单纯疱疹性角膜炎（HSK），表现为角膜溃疡穿孔并伴有大片浸润：吉姆萨涂片显示的多核巨细胞为诊断提供了线索。
Atypical Herpes simplex keratitis (HSK) presenting as a perforated corneal ulcer with a large infiltrate in a contact lens wearer: multinucleated giant cells in the Giemsa smear offered a clue to the diagnosis.
作者信息
Athmanathan S, Pranesh V M, Pasricha G, Garg P, Vemuganti G K, Sharma S
机构信息
Jhaveri Microbiology Centre, LV Prasad Eye Institute, Banjara Hills, Hyderabad, India.
出版信息
BMC Ophthalmol. 2001;1:1. doi: 10.1186/1471-2415-1-1. Epub 2001 Apr 18.
PURPOSE
To report a case of atypical herpes simplex keratitis initially diagnosed as bacterial keratitis, in a contact lens wearer.
RESULTS
Case report of an 18-year-old woman using contact lenses who presented with pain, redness and gradual decrease in vision in the right eye. Examination revealed a paracentral large stromal infiltrate with a central 2-mm perforation. Corneal and conjunctival scrapings were collected for microbiological investigations. Corneal tissue was obtained following penetrating keratoplasty. Corneal scraping revealed no microorganisms. Giemsa stained smear showed multinucleated giant cells. Conjunctival, corneal scrapings and tissue were positive for herpes simplex virus - 1 (HSV) antigen. Corneal tissue was positive for HSV DNA by PCR.
CONCLUSIONS
Atypical HSV keratitis can occur in contact lens wearers. A simple investigation like Giemsa stain may offer a clue to the diagnosis.
目的
报告一例最初被诊断为细菌性角膜炎的非典型单纯疱疹性角膜炎病例，患者为隐形眼镜佩戴者。
结果
病例报告为一名18岁使用隐形眼镜的女性，其右眼出现疼痛、发红及视力逐渐下降。检查发现旁中央有一大片基质浸润，中央有一个2毫米的穿孔。采集角膜和结膜刮片进行微生物学检查。穿透性角膜移植术后获取角膜组织。角膜刮片未发现微生物。吉姆萨染色涂片显示有多核巨细胞。结膜、角膜刮片及组织的单纯疱疹病毒-1（HSV）抗原检测呈阳性。角膜组织经聚合酶链反应（PCR）检测HSV DNA呈阳性。
结论
非典型HSV角膜炎可发生于隐形眼镜佩戴者。像吉姆萨染色这样的简单检查可能为诊断提供线索。
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