title: Atypical Herpes simplex keratitis (HSK) presenting as a perforated corneal ulcer with a large infiltrate in a contact lens wearer: multinucleated giant cells in the Giemsa smear offered a clue to the diagnosis.
abstract: OBJECTIVE
  To report a case of atypical herpes simplex keratitis initially diagnosed as bacterial keratitis, in a contact lens wearer.
  
  
  RESULTS
  Case report of an 18-year-old woman using contact lenses who presented with pain, redness and gradual decrease in vision in the right eye. Examination revealed a paracentral large stromal infiltrate with a central 2-mm perforation. Corneal and conjunctival scrapings were collected for microbiological investigations. Corneal tissue was obtained following penetrating keratoplasty. Corneal scraping revealed no microorganisms. Giemsa stained smear showed multinucleated giant cells. Conjunctival, corneal scrapings and tissue were positive for herpes simplex virus - 1 (HSV) antigen. Corneal tissue was positive for HSV DNA by PCR.
  
  
  CONCLUSIONS
  Atypical HSV keratitis can occur in contact lens wearers. A simple investigation like Giemsa stain may offer a clue to the diagnosis.
authors.affiliation: Jhaveri Microbiology Centre, LV Prasad Eye Institute, Banjara Hills, Hyderabad, India. sreedhar@lvpeye.stph.net
authors.forename: S
authors.initials: S
authors.lastname: Athmanathan
authors.forename: V M
authors.initials: VM
authors.lastname: Pranesh
authors.forename: G
authors.initials: G
authors.lastname: Pasricha
authors.forename: P
authors.initials: P
authors.lastname: Garg
authors.forename: G K
authors.initials: GK
authors.lastname: Vemuganti
authors.forename: S
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D001399:Azure Stains; D003228:Conjunctiva / Q000821:virology; D003263:Contact Lenses, Hydrophilic; D003315:Cornea / Q000821:virology; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000601:surgery / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015726:Giant Cells / Q000473:pathology*; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000601:surgery / Q000821:virology; D015948:Keratoplasty, Penetrating; D016133:Polymerase Chain Reaction; D012422:Rupture, Spontaneous
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D001399:Azure Stains; D004279:DNA, Viral; D000212:Acyclovir