title: Bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis and corneal perforation in a patient with pityriasis rubra pilaris.
abstract: OBJECTIVE
  To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 77-year-old female with pityriasis rubra pilaris was referred for a perforated corneal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir.
  
  
  CONCLUSIONS
  Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacterial superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Kitzmann
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Goins
authors.forename: Nasreen A
authors.initials: NA
authors.lastname: Syed
authors.forename: Michael D
authors.initials: MD
authors.lastname: Wagoner
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000284:Administration, Oral; D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D001424:Bacterial Infections; D002437:Cefazolin / Q000008:administration & dosage; D002442:Ceftazidime / Q000008:administration & dosage; D016039:Corneal Transplantation; D003320:Corneal Ulcer / Q000209:etiology*; D005260:Female; D006801:Humans; D007634:Keratitis / Q000150:complications* / Q000382:microbiology* / Q000628:therapy; D016849:Keratitis, Herpetic / Q000150:complications* / Q000628:therapy; D010916:Pityriasis Rubra Pilaris / Q000150:complications*; D011552:Pseudomonas Infections; D011551:Pseudomonas fluorescens; D013203:Staphylococcal Infections
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D002442:Ceftazidime; D002437:Cefazolin; D000212:Acyclovir