J Korean Ophthalmol Soc.  2018 Oct;59(10):995-999. 10.3341/jkos.2018.59.10.995.

Presumptive Diagnosis of Recurrent Herpes-induced Anterior Uveitis with Acute Hypopyon

• Yoon HG
• Jeong J
• Kim JY

• KMID: 2422591
• DOI: http://doi.org/10.3341/jkos.2018.59.10.995

Abstract

PURPOSE
We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma.
CASE SUMMARY
A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity.
CONCLUSIONS
When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.

Keyword

Anterior uveitis; Endophthalmitis; Herpes simplex virus; Hypopyon

MeSH Terms

Aged, 80 and over
Anterior Chamber
Anti-Bacterial Agents
Corneal Edema
Diagnosis*
Diagnosis, Differential
Endophthalmitis
Fingers
Humans
Inflammation
Intraocular Pressure
Iritis
Keratitis
Keratitis, Dendritic
Male
Recurrence
Simplexvirus
Tears
Uveitis, Anterior*
Visual Acuity
Anti-Bacterial Agents

Figure

• 

  Figure 1 Photograph of the anterior segment and ultrasonograph of the posterior segment in the left eye. (A) At the first visit, conjunctival hyperemia, anterior chamber inflammation were observed. (B) At the second day, clinical findings unexpectedly worsened within a day. Epithelial and stromal edema, localized endothelial keratic precipitates with 2 mm high hypopyon were observed. (C) No obvious echogenicity could be observed at the posterior segment. (D) 1 month after starting antiviral therapy, conjunctival hyperemia, corneal edema, and hypopyon had disappeared. A few corneal peripheral infiltrations and focal iris atrophy remained.

• 

  Figure 2 Photograph of the anterior segment and the fundus of the left eye. (A) On the fifth day after stopping antiviral therapy, recurrence was observed with the same clinical features. (B) 1 month after the antiviral therapy again, symptoms and clinical features were improved. (C) Since anterior symptom had disappeared, no inflammation sign could be observed at the fundus.

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