A Case of Endothelial Keratitis Associated with Immunosuppressant in Kaposi's Varicelliform Eruption

Yong Koo Kang; Myung Jun Kim; Hong Kyun Kim

doi:10.3341/jkos.2016.57.10.1640

Journal List > J Korean Ophthalmol Soc > v.57(10) > 1010434

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Kang, Kim, and Kim: A Case of Endothelial Keratitis Associated with Immunosuppressant in Kaposi's Varicelliform Eruption

Case Report

J Korean Ophthalmol Soc 2016;57(10):1640-1644.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.10.1640

A Case of Endothelial Keratitis Associated with Immunosuppressant in Kaposi's Varicelliform Eruption

Yong Koo Kang, MD, Myung Jun Kim, MD, Hong Kyun Kim, MD, PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Hong Kyun Kim, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea Tel: 82-53-420-5816, Fax: 82-53-426-6552 E-mail: okeye@knu.ac.kr

Received 16 June 2016 Accepted 28 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of endothelial keratitis occurred after reactivation of herpes simplex virus following immunosuppressant therapy for Kaposi's varicelliform eruption.

Case summary

A 23-year-old female was referred for ocular pain and blurred vision. She had atopic dermatitis and was diagnosed with Kaposi's varicelliform eruption on her face after using an immunosuppressant. Slit lamp examination revealed central corneal edema in the right eye. She was initially diagnosed with contact lens-induced keratitis. Subsequently, the contact lens was removed and topical antiviral agent used for prevention of ocular involvement. Four days after treatment, Wesseley immune ring of deep stromal haze and cells in the anterior chamber were present. She was diagnosed with endothelial keratitis caused by reactivation of herpes simplex virus after using an immunosuppressant. Topical steroid, hypertonic saline eye drops and cycloplegic eye drops were added to the treatment for the progression of endothelial keratitis. Corneal edema was decreased 2 weeks after treatment and anterior chamber cells decreased 1 month after treatment. There was no recurrence during the fol-low-up period.

Conclusions

Patients diagnosed with Kaposi's varicelliform eruption after using immunosuppressants should have an ophthalmic examination to confirm ocular involvement; use of appropriate eye drops is necessary for the treatment of corneal involvement.

Keywords: Atopic dermatitis, Cornea edema, Endothelial keratitis, Herpes simplex virus, Kaposi's varicelliform eruption

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Figure 1.

Change of anerior curvature in cornea topography after keratitis. Corneal topography of right eye shows flattening of anterior cornea curvature (white arrow) and central cornea thinning (black arrow) than left eye after keratitis due to reactivation of herpes simplex virus after using an immunosuppressant in Kaposi's varicelliform eruption. OD = oculus dexter; OS = oculus sinister; N = nasal; T = temporal.

Figure 2.

Changes of the cornea after ocular involvement of Kaposi's varicelliform eruption. (A) Slit lamp examination of right eye shows Wessley immune ring of stromal haze. Anterior chamber cells are also present. (B) Decreased corneal edema in right eye is shown after instillation of 1% prednisolone and cycloplegic agent after two weeks of treatment. (C) Anterior chamber cells are not present in right eye after one month. (D) There is no recurrence during the two years of follow up period.

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