Post-COVID Vaccine Resistant Herpetic Keratitis: Experience With Foscarnet
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Yes
Purpose
To analyze a case of recurrent Herpes Simplex keratitis (HSV), with suspected resistance to treatment with first-line antivirals, which was successfully treated with intravenous foscarnet. The aim is to highlight the clinical and therapeutic implications of antiviral resistance and explore treatment alternatives.
Methods
We present the case of a 72-year-old immunocompetent male patient with a history of recurrent herpetic keratitis since 2005, managed with standard antiviral therapy with acyclovir (ACV) and valacyclovir (VACV). In 2022 and 2024, recurrences occurred after vaccination against COVID-19. In his last episode, he developed a dendritic ulcer that progressed to a central geographic ulcer refractory to treatment with topical and systemic ACV and VACV despite 6 weeks of treatment. Given the suspicion of antiviral resistance, intravenous foscarnet was administered.
Results
Treatment with intravenous foscarnet achieved a rapid and complete resolution of the corneal ulcer and the stromal inflammatory condition. The patient showed significant clinical improvement, including reduction in ocular pain and improvement in vision. Corneal immunologi
Conclusion
Intravenous foscarnet is an effective therapeutic option in cases of herpetic keratitis with antiviral resistance. However, its use faces limitations due to its toxicity, availability and high cost, with difficult access, especially in our country, Argentina. This case highlights the need for therapeutic alternatives such as topical foscarnet or combination therapies, and for clinical studies to optimize the management of resistant HSV.
Conflict of interest
No
1
Last name
SOLER
Initials of first name(s)
TB
Department
Oftalmologia
City
CABA
Country
Argentina
2
Last name
SEGRETIN GUTIERREZ
Initials of first name(s)
EFE
Department
Oftalmologia
City
CABA
Country
Argentina
3
Last name
GARCIA
Initials of first name(s)
MM
Department
Oftalmologia
City
CABA
Country
Argentina
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