LoBue Stephen A, Goldman Adam, Giovane Richard A, Carlson Stacy M, Bivona Michael, Albear Sinan, LoBue Thomas D
Department of Ophthalmology, SUNY Downstate, Brooklyn, NY 11203, USA.
LoBue Laser & Eye Medical Centers, Murrieta, CA 92562, USA.
Case Rep Ophthalmol Med. 2020 Dec 28;2020:8861892. doi: 10.1155/2020/8861892. eCollection 2020.
To report a case of a 34-year-old male with recurrent herpes zoster ophthalmicus (HZO) preceded by a 6-week cycle of anabolic steroids and high-dose amino acid supplementation. . A 34-year-old man presented to our institution for left eye pain for one week associated with a vesicular rash in the V1 dermatome, respecting the midline. The patient had no significant past medical or past ocular history, including systemic immunosuppressive agents or HIV. However, prior to the onset of his symptoms the patient had completed a 6-week course of anabolic steroids including trenbolone, deca-durabolin, and testosterone as well as high-dose arginine supplementation averaging more than 40 grams a day. The best-corrected vision was 20/25 OS with slit-lamp examination remarkable for punctate staining and pseudodendrites at 6 o'clock, outside the visual axis. The patient was treated with oral acyclovir 800 mg five times a day for seven days along with prednisolone QID and moxifloxacin QID which was tapered over a month. Four months after resolution, the patient developed a recurrent HZO keratitis preceded by another cycle of anabolic steroids and amino acid supplementation.
In vitro L-arginine supplementation has been associated with the proliferation and virulence of a variety of herpes viruses. Anabolic steroids have also been demonstrated by various studies to negatively affect cell-mediated immunity necessary to prevent viral infection. Thus, it is possible that anabolic steroids in conjunction with increased L-arginine intake may have precipitated a recurrent HZO in a previously healthy, immunocompetent individual.
报告一例34岁男性复发性眼带状疱疹（HZO）病例，其发病前有为期6周的合成代谢类固醇和高剂量氨基酸补充周期。一名34岁男性因左眼疼痛一周并伴有V1皮节出现水疱性皮疹（皮疹沿中线分布）前来我院就诊。该患者既往无重大内科或眼科病史，未使用过全身免疫抑制剂或感染HIV。然而，在症状出现前，患者完成了一个为期6周的合成代谢类固醇疗程，包括群勃龙、癸酸诺龙和睾酮，以及平均每天超过40克的高剂量精氨酸补充。最佳矫正视力为OS 20/25，裂隙灯检查显示在视轴外6点钟位置有点状染色和假树枝状病变。患者接受口服阿昔洛韦800毫克，每日5次，共7天，同时口服泼尼松龙每日4次和莫西沙星每日4次，一个月内逐渐减量。症状消退四个月后，患者在经历了另一个合成代谢类固醇和氨基酸补充周期后，出现了复发性HZO角膜炎。结论：体外补充L-精氨酸与多种疱疹病毒的增殖和毒力有关。多项研究还表明，合成代谢类固醇会对预防病毒感染所需的细胞介导免疫产生负面影响。因此，在一名既往健康、免疫功能正常的个体中，合成代谢类固醇与L-精氨酸摄入量增加相结合可能引发了复发性HZO。
