Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

Liam Daniel Turner,1 Peter Beckingsale1,2,31Princess Alexandra Hospital; 2Terrace Eye Centre; 3Laser Sight, Brisbane, Queensland, AustraliaPurpose: To report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluri...

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Autores principales:	Turner LD, Beckingsale P
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/53839aa7bff74533881317a220decaed
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spelling	oai:doaj.org-article:53839aa7bff74533881317a220decaed2021-12-02T00:08:21ZAcyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression1177-54671177-5483https://doaj.org/article/53839aa7bff74533881317a220decaed2013-01-01T00:00:00Zhttp://www.dovepress.com/acyclovir-resistant-herpetic-keratitis-in-a-solid-organ-transplant-rec-a12078https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Liam Daniel Turner,1 Peter Beckingsale1,2,31Princess Alexandra Hospital; 2Terrace Eye Centre; 3Laser Sight, Brisbane, Queensland, AustraliaPurpose: To report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluridine.Methods: A case of a 35-year-old female with herpetic epithelial keratitis resistant to acyclovir is described. The patient presented following treatment for 4 weeks with topical acyclovir ointment five times per day and oral valacyclovir 1 g three times per day for herpetic keratitis with no resolution of the epithelial defect or symptoms. Corneal scrapes and swabs were taken for confirmation of the diagnosis and resistance testing. The results were positive for herpes simplex virus 1 and showed acyclovir resistance (inhibitor concentration 90 = 200 &micro;g/mL) and foscarnet sensitivity (inhibitor concentration 90 = 200 &micro;g/mL). The patient was treated with topical trifluridine 2-hourly for 3 weeks and weaned off the drops over the following week.Results: The patient showed resolution of the epithelial defect, but did have significant corneal toxicity associated with the use of the trifluridine. At 8 weeks, the patient had some stromal shadowing associated with the recent active infection, but symptoms had settled.Conclusion: This case documents the effective use of topical trifluridine in proven acyclovir-resistant herpetic keratitis. It highlights three things: (1) the importance of considering topical trifluridine as an alternative to topical acyclovir in unresponsive disease; (2) the need to consider solid-organ transplant recipients in the immunocompromised population with resistant herpetic disease, and (3) the need to look for alternatives to treatment of resistant herpetic disease.Keywords: acyclovir resistance, herpetic keratitis, trifluridineTurner LDBeckingsale PDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2013, Iss default, Pp 229-232 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Turner LD Beckingsale P Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
description	Liam Daniel Turner,1 Peter Beckingsale1,2,31Princess Alexandra Hospital; 2Terrace Eye Centre; 3Laser Sight, Brisbane, Queensland, AustraliaPurpose: To report a case of acyclovir-resistant herpetic keratitis in a solid-organ lung transplant recipient that was effectively treated with topical trifluridine.Methods: A case of a 35-year-old female with herpetic epithelial keratitis resistant to acyclovir is described. The patient presented following treatment for 4 weeks with topical acyclovir ointment five times per day and oral valacyclovir 1 g three times per day for herpetic keratitis with no resolution of the epithelial defect or symptoms. Corneal scrapes and swabs were taken for confirmation of the diagnosis and resistance testing. The results were positive for herpes simplex virus 1 and showed acyclovir resistance (inhibitor concentration 90 = 200 &micro;g/mL) and foscarnet sensitivity (inhibitor concentration 90 = 200 &micro;g/mL). The patient was treated with topical trifluridine 2-hourly for 3 weeks and weaned off the drops over the following week.Results: The patient showed resolution of the epithelial defect, but did have significant corneal toxicity associated with the use of the trifluridine. At 8 weeks, the patient had some stromal shadowing associated with the recent active infection, but symptoms had settled.Conclusion: This case documents the effective use of topical trifluridine in proven acyclovir-resistant herpetic keratitis. It highlights three things: (1) the importance of considering topical trifluridine as an alternative to topical acyclovir in unresponsive disease; (2) the need to consider solid-organ transplant recipients in the immunocompromised population with resistant herpetic disease, and (3) the need to look for alternatives to treatment of resistant herpetic disease.Keywords: acyclovir resistance, herpetic keratitis, trifluridine
format	article
author	Turner LD Beckingsale P
author_facet	Turner LD Beckingsale P
author_sort	Turner LD
title	Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
title_short	Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
title_full	Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
title_fullStr	Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
title_full_unstemmed	Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
title_sort	acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/53839aa7bff74533881317a220decaed
work_keys_str_mv	AT turnerld acyclovirresistantherpetickeratitisinasolidorgantransplantrecipientonsystemicimmunosuppression AT beckingsalep acyclovirresistantherpetickeratitisinasolidorgantransplantrecipientonsystemicimmunosuppression
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Acyclovir-resistant herpetic keratitis in a solid-organ transplant recipient on systemic immunosuppression

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