Monkeypox-Associated Disciform Keratitis

Abstract

Purpose: The purpose of this study was to describe a case of monkeypox (MPX)-associated disciform keratitis.

Methods: This is a case report.

Results: A 36-year-old male patient presented to the infectious diseases clinic with a 1-week history of disseminated pustular skin lesions, a 4-day history of constitutional symptoms, and redness in the left eye. Testing of blood, 2 skin lesions, and a conjunctival swab confirmed the presence of MPX virus by polymerase chain reaction. On ophthalmologic examination on the 17th day of illness, there was a corneal epithelial ridge that stained with fluorescein with disciform corneal edema and underlying keratic precipitates. The patient was treated with oral tecovirimat 600 mg twice a day for 14 days and topical prednisolone acetate 1% 4 times daily, starting 2 days later. On completion of oral treatment, his corneal findings had resolved except for a small subepithelial scar at which time topical steroids were tapered.

Conclusions: MPX may cause disciform keratitis and scarring that closely resembles other ocular viral infections. Clinical trials are urgently needed to define the optimal management of human MPX infections and reduce vision loss.

FIGURE 1.

A slitlamp photograph of patient's left eye showing an irregular corneal epithelial ridge, which stained with fluorescein and disciform keratitis (stromal edema with underlying keratic precipitates).

FIGURE 2.

Photograph of papules noted on physical examination of the patient's back on day 26 which were positive for monkeypox polymerase chain reaction and emerged while receiving tecovirimat 600 mg twice daily.

FIGURE 3.

A slitlamp photograph of patient's left eye demonstrating subepithelial corneal scarring (3 weeks after initiation of oral tecovirimat and topical steroids).