Anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis associated with herpes zoster

Abstract

AIM: To analyze etiopathogenesis, clinical features, and a treatment algorithm for acute anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis in order to increase medical awareness of herpes zoster in children.

RESULTS: Long-term exposure to rapid temperature changes contributed to varicella-zoster virus (VZV) reactivation in a child leading to herpes zoster rarely occurring in children, onset of anterior diffuse scleritis and hypopyon anterior uveitis. Corticosteroid therapy without causal treatment led to herpes virus reactivation in the patient’s cornea which contributed to herpes corneal ulcer.

CONCLUSION: Etiopathogenesis features were analyzed, characteristic clinical symptoms of anterior diffuse scleritis, herpes corneal ulcer, and hypopyon anterior uveitis caused by varicella-zoster virus (VZV) reactivation were described. Reactivation led to herpes zoster with skin eruption and herpes zoster ophthalmicus, such as injury of the ophthalmic branch of the trigeminal nerve without extraocular (skin) symptoms of herpes infection. The VZV etiological role was established based on high titers of anti-VZV IgG antibodies, the presence of anti-VZV-gE IgG antibodies (markers of active viral replication), and the efficacy of anti-herpes therapy. The described clinical symptoms of combined ophthalmic pathology contribute to the early diagnosis of ocular herpes for timely antiviral herpes therapy to prevent chronic disease and complications and to preserve and/or recover visual acuity.

Keywords

children / scleritis / anterior uveitis / herpetic corneal ulcer / laboratory diagnosis / varicella-zoster virus / treatment

References

[1] Vikulov GKh, Oradovskaya IV, Kolobukhina LV. Herpesvirus infections in children: prevalence, incidence, clinical forms, and management algorithm. Clinical practice in pediatrics. 2022;17(6):126–141. EDN: QQTSMW DOI: 10.20953/1817-7646-2022-6-126-140

[2] Викулов Г.Х., Орадовская И.В., Колобухина Л.В. Герпесвирусные инфекции у детей: распространенность, заболеваемость, клинические формы и алгоритм ведения // Вопросы практической педиатрии. 2022. Т. 17, № 6. С. 126–141. EDN: QQTSMW doi: 10.20953/1817-7646-2022-6-126-140

[3] Roizman BK, Knipe D, Whitley RJ. Herpes simplex viruses. Philadelphia: Lippincott-Williams &Wilkins; 2013. Р. 1823–1897.

[4] Roizman B.K., Knipe D., Whitley R.J. Herpes simplex viruses. Philadelphia: Lippincott-Williams &Wilkins, 2013. Р. 1823–1897.

[5] Poole E, Wills M, Sinclair J. Human cytomegalovirus latency: targeting differences in the latently infected cell with a view to clearing latent infection. New J Sci. 2014;2:1–10. doi: 10.1155/2014/313761

[6] Poole E., Wills M., Sinclair J. Human cytomegalovirus latency: targeting differences in the latently infected cell with a view to clearing latent infection // New J Sci. 2014. Vol. 2. P. 1–10. doi: 10.1155/2014/313761

[7] Arvin A, Campadelli-Fiume G, Mocarski E, et al. Human herpesviruses: biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press; 2007. doi: 10.1017/CBO9780511545313

[8] Arvin A., Campadelli-Fiume G., Mocarski E., et al. Human herpesviruses: biology, therapy, and immunoprophylaxis. Cambridge: Cambridge University Press, 2007. doi: 10.1017/CBO9780511545313

[9] West JA, Gregory SM, Damania B. Toll-like receptor sensing of human herpesvirus infection. Front Cell Infect Microbiol. 2012;2:122. doi: 10.3389/fcimb.2012.00122

[10] West J.A., Gregory S.M., Damania B. Toll-like receptor sensing of human herpesvirus infection // Front Cell Infect Microbiol. 2012. Vol. 2. P. 122. doi: 10.3389/fcimb.2012.00122

[11] Alekseev KP, Alimbarova LM, Aliper TI, et al. Viruses and viral infections of humans and animals. Handbook of virology. Moscow: Meditsinskoe informatsionnoe agentstvo; 2013. 1200 р. EDN: TLZMHF

[12] Львов Д.К., Алексеев К.П., Алимбарова Л.М., и др. Вирусы и вирусные инфекции человека и животных. Руководство по вирусологии / под ред. Д.К. Львова. Москва: Медицинское информационное агентство, 2013. 1200 с. EDN: TLZMHF

[13] Vikulov GKh. Human herpesvirus infections in the new millennium: classification, epidemiology, and sociomedical importance. Epidemiology and infectious diseases. Current items. 2014;(3):35–40. EDN: SWNYJN

[14] Викулов Г.Х. Герпесвирусные инфекции человека в новом тысячелетии: классификация, эпидемиология и медико-социальное значение // Эпидемиология и инфекционные болезни. Актуальные вопросы. 2014. № 3. С. 35–40. EDN: SWNYJN

[15] Zhang J, Liu H, Wei B. Immune response of T cells during herpes simplex virus type 1 (HSV-1) infection. J Zhejiang Univ Sci B. 2017;18(4):277–288. doi: 10.1631/jzus.B1600460

[16] Zhang J., Liu H., Wei B. Immune response of T cells during herpes simplex virus type 1 (HSV-1) infection // J Zhejiang Univ Sci B. 2017. Vol. 18, N 4. P. 277–288. doi: 10.1631/jzus.B1600460

[17] Zheng W, Xu Q, Zhang Y, et al. Toll-like receptor-mediated innate immunity against herpesviridae infection: a current perspective on viral infection signaling pathways. Virol J. 2020;17(1):192. doi: 10.1186/s12985-020-01463-2

[18] Zheng W., Xu Q., Zhang Y., et al. Toll-like receptor-mediated innate immunity against herpesviridae infection: a current perspective on viral infection signaling pathways // Virol J. 2020. Vol. 17, N 1. P. 192. doi: 10.1186/s12985-020-01463-2

[19] Connolly SA, Jardetzky TS, Longnecker R. The structural basis of herpesvirus entry. Nat Rev Microbiol. 2021;19(2):110–121. doi: 10.1038/s41579-020-00448-w

[20] Connolly S.A., Jardetzky T.S., Longnecker R. The structural basis of herpesvirus entry // Nat Rev Microbiol. 2021. Vol. 19, N 2. P. 110–121. doi: 10.1038/s41579-020-00448-w

[21] Maksimova MY. Neurological disorders in herpes zoster. MedicaMente. Lechim s umom. 2017;3(1):21–24. (In Russ.) EDN: ZIVSVL

[22] Максимова М.Ю. Неврологические нарушения при опоясывающем герпесе // MedicaMente. Лечим с умом. 2017. Т. 3, № 1. С. 21–24. EDN: ZIVSVL

[23] Kennedy PG, Gershon AA. Clinical features of varicella-zoster virus infection. Viruses. 2018;10(11):609. doi: 10.3390/v10110609

[24] Kennedy P.G., Gershon A.A. Clinical features of varicella-zoster virus infection // Viruses. 2018. Vol. 10, N 11. P. 609. doi: 10.3390/v10110609

[25] Gershon AA, Breuer J, Cohen JI, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015;1:15016. doi: 10.1038/nrdp.2015.16

[26] Gershon A.A., Breuer J., Cohen J.I., et al. Varicella zoster virus infection // Nat Rev Dis Primers. 2015. Vol. 1. P. 15016. doi: 10.1038/nrdp.2015.16

[27] Mitra B, Chopra A, Talukdar K, et al. Clinico-epidemiological study of childhood herpes zoster. Indian Dermatol Online J. 2018;9(6):383–388. doi: 10.4103/idoj.IDOJ_107_18

[28] Mitra B., Chopra A., Talukdar K., et al. Clinico-epidemiological study of childhood herpes zoster // Indian Dermatol Online J. 2018. Vol. 9, N 6. P. 383–388. doi: 10.4103/idoj.IDOJ_107_18

[29] Hakim FE, Riaz K, Farooq A. Pediatric herpes zoster ophthalmicus: a systematic review. Graefes Arch Clin Exp Ophthalmol. 2023;261(8):2169–2179. doi: 10.1007/s00417-023-06033-0

[30] Hakim F.E., Riaz K., Farooq A. Pediatric herpes zoster ophthalmicus: a systematic review // Graefes Arch Clin Exp Ophthalmol. 2023. Vol. 261, N 8. P. 2169–2179. doi: 10.1007/s00417-023-06033-0

[31] Anne L, Mounsey MD, Leah G, et al. Herpes zoster and postherpetic neuralgia: treatment and prevention. Russian Journal of Skin and Venereal Diseases. 2007;(S2):54–57. (In Russ.) EDN: IBIDTF

[32] Anne L., Mounsey M.D., Leah G., и др. Опоясывающий герпес и постгерпетическая невралгия: профилактика и лечение // Российский журнал кожных и венерических болезней. 2007. № S2. С. 54–57. EDN: IBIDTF

[33] Khaldin AA. Postherpetic neuralgia: possible therapeutic consensus of dermatologists and neurologists. Klinicheskaya dermatologiya i venerologiya = Russian journal of clinical dermatology and venereology. 2018;17(1):77–81. EDN: YURDON doi: 10.17116/klinderma201817177-81

[34] Халдин А.А. Опоясывающий герпес и постгерпетические невралгии: возможный терапевтический консенсус дерматологов и неврологов // Клиническая дерматология и венерология. 2018. Т. 17, № 1. С. 77–81. EDN: YURDON doi: 10.17116/klinderma201817177-81

[35] Molochkov VA, Shabalin VN, Kryazheva SS, Romanenko GF. Manual on gerontological dermatology. Moscow: MONIKI; 2004. 359 р. (In Russ.) EDN: QLLPGZ

[36] Молочков В.А., Шабалин В.Н., Кряжева С.С., Романенко Г.Ф. Руководство по геронтологической дерматологии. Москва: МОНИКИ, 2004. 359 с. EDN: QLLPGZ

[37] Kong CL, Thompson RR, Porco TC, et al. Incidence rate of herpes zoster ophthalmicus: a retrospective cohort study from 1994 through 2018. Ophthalmology. 2020;127(3):324–330. doi: 10.1016/j.ophtha.2019.10.001

[38] Kong C.L., Thompson R.R., Porco T.C., et al. Incidence rate of herpes zoster ophthalmicus: a retrospective cohort study from 1994 through 2018 // Ophthalmology. 2020. Vol. 127, N 3. P. 324–330. doi: 10.1016/j.ophtha.2019.10.001

[39] Vikulov GKh, Maksimova MYu, Voznesenskiy SL, et al. Herpes zoster: epidemiology, clinical manifestations, algorithms of diagnosis, treatment, and prevention. Infectious Disease. 2019;17(2):105–120. EDN: KDCPXT doi: 10.20953/1729-9225-2019-2-105-120

[40] Викулов Г.Х., Максимова М.Ю., Вознесенский С.Л., и др. Опоясывающий герпес: эпидемиология, клиника, алгоритмы диагностики, лечения и профилактики // Инфекционные болезни. 2019. Т. 17, № 2. С. 105–120. EDN: KDCPXT doi: 10.20953/1729-9225-2019-2-105-120

[41] Lavrov VF, Svitich OA, Kazanova AS, et al. Varicella Zoster virus infection: immunity, diagnosis and modelling in vivo. Journal of microbiology, epidemiology and immunobiology = Zhurnal mikrobiologii, epidemiologii i immunobiologii. 2019;(4):82–89. EDN: HWKYDO doi: 10.36233/0372-9311-2019-4-82-89

[42] Лавров В.Ф., Свитич О.А., Казанова А.С., и др. Varicella Zoster-вирусная инфекция: иммунитет, диагностика и моделирование in vivo // Журнал микробиологии, эпидемиологии и иммунобиологии. 2019. № 4. С. 82–89. EDN: HWKYDO doi: 10.36233/0372-9311-2019-4-82-89

[43] Kovaleva LA, Krichevskaya GI, Davydova GA, Zaitseva AA. Chronic unilateral anterior nodular scleritis with local inflammation of the ciliary body associated with the varicella-zoster virus. Russian pediatric ophthalmology = Rossiyskaya pediatricheskaya oftal’mologiya. 2022;17(2):31–38. EDN: HZNBGM doi: 10.17816/rpoj105641

[44] Ковалева Л.А., Кричевская Г.И., Давыдова Г.А., Зайцева А.А. Хронический односторонний передний узелковый склерит с локальным поражением цилиарного тела, ассоциированный с вирусом варицелла-зостер // Российская педиатрическая офтальмология. 2022. Т. 17, № 2. C. 31–38. EDN: HZNBGM doi: 10.17816/rpoj105641

[45] State report of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare “On the state of sanitary-epidemiological well-being of the population in the Russian Federation in 2021”. (In Russ.) Available from: https://base.garant.ru/409074716/. Accessed: 05.11.2024.

[46] Государственный доклад Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека «О состоянии санитарно-эпидемиологического благополучия населения в Российской Федерации в 2021 году». Режим доступа: https://base.garant.ru/409074716/. Дата обращения: 05.11.2024.

RIGHTS & PERMISSIONS

Eco-Vector