Department of Medicine, Creighton University School of Medicine and CHI Health, Omaha, NE, 68105, USA.
Vance Thompson Vision, Omaha, NE, 68137, USA.
BMC Infect Dis. 2023 Jul 12;23(1):465. doi: 10.1186/s12879-023-08414-6.
Corneal transplants are the most common type of transplant and increasing in frequency. Donor cornea tissues are a rare source of herpes simplex virus (HSV) transmission and not routinely tested for presence of HSV. Donor graft-to-recipient transmission typically causes graft failure and anterior uveitis, and extra-ocular HSV disease has not been previously reported. We present a case of HSV transmission from donor cornea tissue that nearly cost the corneal transplant recipient his life.
An elderly immunocompetent man developed an acute illness 10 days after having donor corneal tissue implanted in a Descemet membrane endothelial keratoplasty (DMEK). He was found to have HSV necrotizing hepatitis per liver biopsy, trilineage cytopenia, rhabdomyolysis, acute kidney failure, altered mental status, early-stage hemophagocytic lymphohistiocytosis (HLH), and donor corneal tissue implant infection resulting in graft failure and anterior uveitis. HSV DNA was detected in cerebral spinal fluid, peripheral blood, explanted donor corneal tissue, and anterior chamber fluid (220 million HSV DNA copies per mL). HSV-1 seroconversion denoted a primary HSV infection, and the patient had no other risk factor for HSV acquisition. Early recognition of HSV dissemination prompting treatment with intravenous acyclovir, as well as a short course of HLH-directed therapy, resolved the systemic illness. Vision was restored to near normal by replacement of the infected corneal graft with new donor DMEK tissue in conjunction with intravitreal foscarnet treatment.
Awareness of the potential risk of donor cornea tissue transmitting HSV and leading to life-threatening HSV disease is paramount to early diagnosis and treatment. The role of donor cornea tissue in HSV transmission and disease merits additional attention and investigation.
角膜移植是最常见的移植类型，且其频率正在增加。供体角膜组织是单纯疱疹病毒（HSV）传播的罕见来源，并且通常不进行 HSV 存在情况的检测。供体移植物向受者的传播通常导致移植物失功和前葡萄膜炎，并且眼部 HSV 疾病以前没有报道过。我们报告了一例由供体角膜组织传播的 HSV 病例，该病例几乎使角膜移植受者失去生命。
一名免疫功能正常的老年男性在接受 Descemet 膜内皮角膜移植术（DMEK）中植入供体角膜组织 10 天后，出现急性疾病。他的肝活检显示 HSV 坏死性肝炎、三系细胞减少症、横纹肌溶解症、急性肾衰竭、精神状态改变、早期噬血细胞性淋巴组织细胞增生症（HLH）和供体角膜组织植入物感染导致移植物失功和前葡萄膜炎。在脑脊髓液、外周血、移植的供体角膜组织和前房液中检测到 HSV DNA（每毫升 2.2 亿 HSV DNA 拷贝）。HSV-1 血清转化表示原发性 HSV 感染，且患者没有获得 HSV 的其他危险因素。早期识别 HSV 播散并促使使用阿昔洛韦静脉注射治疗，以及短程 HLH 靶向治疗，解决了全身疾病。通过用新的供体 DMEK 组织替换受感染的角膜移植物并结合玻璃体内膦甲酸治疗，恢复了接近正常的视力。
意识到供体角膜组织传播 HSV 并导致危及生命的 HSV 疾病的潜在风险对于早期诊断和治疗至关重要。供体角膜组织在 HSV 传播和疾病中的作用值得进一步关注和研究。
