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Case Reports
. 2017 Dec 13:9:68-71.
doi: 10.1016/j.ajoc.2017.12.002. eCollection 2018 Mar.

A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease

Prachi Dua  1 , Roman Shinder  1 , Derek B Laskar  2 , Douglas R Lazzaro  1 , Allison E Rizzuti  1
Affiliations
Case Reports

A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease

Prachi Dua et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To report a case of hypertrophic herpes simplex virus (HSV) of the eyelid and cornea masquerading as IgG4-related disease.

Observations: A 37-year old African American female with a past medical history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and a recent history of treated genital herpes, presented with an ulcerative lesion of the left upper and lower eyelids, and severe ocular inflammation with symblepharon. Initially, eyelid biopsy revealed findings consistent with IgG4-related disease, and the patient was treated with high dose oral prednisone. After one week of therapy, there was no improvement in the patient's symptoms, and she subsequently developed a corneal epithelial defect which progressed to chronic ulceration. Repeat biopsy and corneal cultures revealed herpes simplex virus type 2. The patient was treated with high dose acyclovir, and the lid lesion improved. The conjunctival inflammation and corneal epithelial defect resolved but symblepharon restricting her eye movement remained. She also developed corneal vascularization and opacification causing severe vision loss.

Conclusions and importance: Chronic hypertrophic herpes simplex virus infection is a rare condition reported in patients with HIV. While there have been few reports of hypertrophic HSV affecting the eyelid, this is the first reported case of hypertrophic HSV affecting the eye, resulting in severe vision loss.

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Figures

Fig. 1
Fig. 1
A: Photograph of ulcerative lesion centered at left medial canthus. B: Biopsy shows dense polytypic plasma cell infiltrate in background of fibrosis, acute and chronic inflammation (hematoxylin & eosin stain, 400). C: Immunochemistry of the biopsy shows IgG4 plasma cell infiltrate (>100 per high-power field) with IgG4:IgG ratio > 40% (immunostain, ×400).
Fig. 2
Fig. 2
A: Photograph of corneal epithelial defect. B: Photograph of enlarged corneal epithelial defect.
Fig. 3
Fig. 3
A: Hematoxylin & eosin stain shows syncytial and scattered epithelial cells with viral cytopathic effect (smudged, “ground glass” intranuclear inclusions) in a background of acute inflammation and necrosis (hematoxylin & eosin stain, x 400). B: Herpes simplex virus immunostain highlighting scattered herpes simplex virus positive cells (immunostain, ×400).
Fig. 4
Fig. 4
Photograph of improved eyelid lesion with residual symblepheraon and corneal opacification.
See this image and copyright information in PMC

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