Journal article
Herpes simplex virus dissemination with necrotizing hepatitis following Descemet membrane endothelial keratoplasty
BMC infectious diseases, Vol.23(1), 465
07/12/2023
DOI: 10.1186/s12879-023-08414-6
PMCID: PMC10339553
PMID: 37438705
Abstract
Background
Corneal transplants are the most common type of transplant and increasing in frequency. Donor cornea tissues are a rare source of herpes simplex virus (HSV) transmission and not routinely tested for presence of HSV. Donor graft-to-recipient transmission typically causes graft failure and anterior uveitis, and extra-ocular HSV disease has not been previously reported. We present a case of HSV transmission from donor cornea tissue that nearly cost the corneal transplant recipient his life.
Case report
An elderly immunocompetent man developed an acute illness 10 days after having donor corneal tissue implanted in a Descemet membrane endothelial keratoplasty (DMEK). He was found to have HSV necrotizing hepatitis per liver biopsy, trilineage cytopenia, rhabdomyolysis, acute kidney failure, altered mental status, early-stage hemophagocytic lymphohistiocytosis (HLH), and donor corneal tissue implant infection resulting in graft failure and anterior uveitis. HSV DNA was detected in cerebral spinal fluid, peripheral blood, explanted donor corneal tissue, and anterior chamber fluid (220 million HSV DNA copies per mL). HSV-1 seroconversion denoted a primary HSV infection, and the patient had no other risk factor for HSV acquisition. Early recognition of HSV dissemination prompting treatment with intravenous acyclovir, as well as a short course of HLH-directed therapy, resolved the systemic illness. Vision was restored to near normal by replacement of the infected corneal graft with new donor DMEK tissue in conjunction with intravitreal foscarnet treatment.
Conclusion
Awareness of the potential risk of donor cornea tissue transmitting HSV and leading to life-threatening HSV disease is paramount to early diagnosis and treatment. The role of donor cornea tissue in HSV transmission and disease merits additional attention and investigation.
Details
- Title: Subtitle
- Herpes simplex virus dissemination with necrotizing hepatitis following Descemet membrane endothelial keratoplasty
- Creators
- Ahad Azeem - Creighton UniversityBrandon Baartman - Vance Thompson VisionChristopher D. Conrady - University of Nebraska Medical CenterJeffery L. Meier - University of IowaRima El-Herte - Creighton University
- Resource Type
- Journal article
- Publication Details
- BMC infectious diseases, Vol.23(1), 465
- DOI
- 10.1186/s12879-023-08414-6
- PMID
- 37438705
- PMCID
- PMC10339553
- NLM abbreviation
- BMC Infect Dis
- ISSN
- 1471-2334
- eISSN
- 1471-2334
- Publisher
- BioMed Central
- Grant note
- ; BLRD Merit grant I01BX004434 / ;
- Language
- English
- Date published
- 07/12/2023
- Academic Unit
- Infectious Diseases; Epidemiology; Internal Medicine
- Record Identifier
- 9984444765002771
Metrics
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