Yoshida Masaaki, Hosogai Mayumi, Yokokura Shunji, Sato Kota, Hariya Takehiro, Kobayashi Wataru, Okabe Tatsu, Todokoro Daisuke, Nakazawa Toru
Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Ophthalmology, Gunma University Graduate School of Medicine, Maebashi, Japan.
Cornea. 2019 Sep;38(9):1185-1188. doi: 10.1097/ICO.0000000000002026.
To report a case of severe bilateral necrotizing herpes simplex keratitis (HSK) in an immunocompetent patient, with genotyping of the underlying herpes simplex virus 1 (HSV-1).
Genetic analyses of HSV-1 in tear samples were performed with polymerase chain reaction-based restriction fragment length polymorphism, targeting the viral genes unique short (US)2, US4 (glycoprotein G), and US7 (glycoprotein I).
A 64-year-old woman with no history of atopy or immune disorders manifested bilateral keratitis with geographic ulcer. Her initial visual acuity was 20/1000 (OD) and 20/20 (OS). Polymerase chain reaction testing of a tear sample revealed the presence of HSV-1 in both eyes, and the patient was diagnosed with bilateral HSK. Both eyes progressed to necrotizing keratitis during the treatment course. Continuous intensive treatment, at first with acyclovir ointment and oral valacyclovir and later with steroid eye drops for stromal keratitis, finally improved the patient's condition. However, after 2 years, her visual acuity was limited to 20/250 (OD) and 20/60 (OS) because of corneal opacity from scarring. We found that the strain in the current case had a genotype combination of C/A/B (for US2/US4/US7), a known pattern in Japan, in both eyes.
We successfully performed an unprecedented genetic analysis of an HSV-1 strain isolated from a case of bilateral necrotizing HSK in an immunocompetent patient. The association of the HSV-1 genotype with the clinical manifestation remains unclear, calling for more data from new cases, especially from different geographic regions.
报告一例免疫功能正常患者发生的严重双侧坏死性单纯疱疹病毒性角膜炎（HSK）病例，并对其潜在的单纯疱疹病毒1型（HSV-1）进行基因分型。
采用基于聚合酶链反应的限制性片段长度多态性方法，对泪液样本中的HSV-1进行基因分析，靶向病毒基因独特短片段（US）2、US4（糖蛋白G）和US7（糖蛋白I）。
一名64岁女性，无特应性或免疫疾病史，表现为双侧地图状溃疡角膜炎。其初始视力为右眼20/1000，左眼20/20。泪液样本的聚合酶链反应检测显示双眼均存在HSV-1，该患者被诊断为双侧HSK。在治疗过程中，双眼均进展为坏死性角膜炎。起初使用阿昔洛韦眼膏和口服伐昔洛韦进行持续强化治疗，后来因基质性角膜炎使用类固醇眼药水，最终改善了患者的病情。然而，2年后，由于瘢痕形成导致角膜混浊，其视力仅为右眼20/250，左眼20/60。我们发现本例中的毒株在双眼均具有C/A/B（针对US2/US4/US7）的基因型组合，这是日本已知的一种模式。
我们成功地对一名免疫功能正常患者双侧坏死性HSK病例中分离出的HSV-1毒株进行了前所未有的基因分析。HSV-1基因型与临床表现之间的关联仍不清楚，需要更多新病例的数据，尤其是来自不同地理区域的数据。
