Herpetic Keratitis with Atypical Clinical Presentation: A Case Report
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Purpose
To highlight atypical clinical manifestations of herpetic keratitis and discuss potential therapeutic approaches.
Methods
We report the case of a 9-year-old child referred to a tertiary Ophthalmology service after a corneal lesion in the right eye was identified in primary care. The patient’s only complaints were occasional ocular itching and redness. Ophthalmological examination revealed superficial punctate keratopathy with central corneal opacities in the right eye, while the left eye was unremarkable. Serological tests for herpes and syphilis were requested, and treatment with topical losartan 0.8 mg/mL was initiated. At a follow-up visit one month later, the patient reported no complaints, and examination revealed improved corneal transparency. The diagnosis of herpes was confirmed by positive serological results, leading to the initiation of oral acyclovir treatment. At the most recent visit, the patient was asymptomatic with progressive healing of the ocular lesion, having adhered to the prescribed treatment.
Results
This case highlights atypical manifestations of herpetic keratitis, presenting with few symptoms and a prolonged course, diverging from the classic acute onset with pain, blurred vision, photophobia, and watery discharge. This underscores the importance of a high index of suspicion for ocular herpes, particularly in pediatric patients, given the potential risk of blindness. Additionally, topical losartan showed significant improvement in corneal healing.
Conclusion
Clinicians should remain vigilant for atypical presentations of corneal diseases to ensure accurate diagnosis and prevent severe complications such as blindness. Topical losartan may be a promising therapy for enhancing corneal lesion regeneration.
Conflict of interest
No
1
Last name
RIBEIRO
Initials of first name(s)
G B
Department
Federal University of Santa Maria
City
Santa Maria
Country
Brazil
2
Last name
LEBER
Initials of first name(s)
M
Department
Federal University of Santa Maria
City
Santa Maria
Country
Brazil
3
Last name
VARGAS
Initials of first name(s)
M A
Department
Federal University of Santa Maria
City
Santa Maria
Country
Brazil
4
Last name
Grellmann
Initials of first name(s)
L V
Department
Federal University of Santa Maria
City
Santa Maria
Country
Brazil
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