Herpes Simplex Keratitis in Rheumatoid Arthritis Patients

Abstract

The characteristics of HSK in patients with RA differed from HSK in immunocompetent patients. The stromal keratitis cases were very aggressive and difficult to manage, with perforation and gram-positive bacterial co-infection as frequently associated conditions. Prophylactic therapy at standard doses was unsuccessful to avoid recurrences.

Epithelial Keratitis After Cataract Surgery

“…23 Immunosuppressive agents used in rheumatoid disease (Table 3, cases 6 and7) could also have played a role in HSK reactivation. 24…”

Incidence and Risk Factors of Bilateral Herpetic Keratitis: 2022 Update

“…A study conducted in India reported a notably higher incidence of bilateral HSV keratitis, up to 25% of all herpetic keratitis cases [13]. Higher bilateral rates have also been reported in pediatric patients [14] and in patients with immunosuppression or other underlying conditions [15,16]. Table 1 summarizes the incidence rates reported in literature.…”

“…PUK can pose a diagnostic dilemma in cases with immune system disorders, such as rheumatoid arthritis. Excluding infectious agents is mandatory for appropriate treatment [16,19,20].…”

“…Stromal keratitis cases were very aggressive and difficult to manage, with perforation and Gram-positive bacterial co-infection as frequently associated conditions. Prophylactic therapy at standard doses has proven unsuccessful to prevent recurrences [16]. These patients of course are usually under antiinflammatory/immunosuppressive treatment that also favors the reactivation of HSV.…”

“…Another study, though, regarding patients with rheumatoid arthritis and bilateral herpetic keratitis showed that prophylactic therapy at standard doses did not offer any benefit in avoiding recurrences, highlighting, however, the need for intense monitoring [16].…”