Chronic varicella-zoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome.
OBJECTIVE
To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS).


METHODS
Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome.


RESULTS
Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable.


CONCLUSIONS
In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.
Francis I. Proctor Foundation, University of California San Francisco Medical Center, USA.
K C
KC
Chern
D
D
Conrad
G N
GN
Holland
D S
DS
Holsclaw
L K
LK
Schwartz
T P
TP
Margolis
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001086:Arabinofuranosyluracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002908:Chronic Disease; D019573:Epithelium, Corneal / Q000473:pathology / Q000821:virology*; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007635:Keratitis, Dendritic / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000998:Antiviral Agents; D001086:Arabinofuranosyluracil; C031368:sorivudine; D000212:Acyclovir