title: Recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection: a case report.
abstract: OBJECTIVE
  To report recurrent conjunctivitis and scleritis secondary to coexistent conjunctival pemiphigus vulgaris and cryptic herpes simplex infection.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Retrospective review.
  
  
  RESULTS
  A 54-year-old woman presented with recurrent left eye irritation and redness. Four years earlier, she was diagnosed (biopsy) with cutaneous pemphigus vulgaris requiring immunomodulatory therapies. She was receiving oral acyclovir for recurrent genital herpes and intravenous immunoglobulin for pemphigus. Examination revealed unilateral necrotizing scleritis and conjunctivitis. Immunohistochemical staining of biopsies demonstrated conjunctival pemphigus and herpes in conjunctiva and sclera. Valacyclovir therapy brought resolution.
  
  
  CONCLUSIONS
  Cryptic ocular herpes may confound matters in someone with an autoimmune disease thought to be the sole source of ocular inflammation. Immunohistochemical analysis can resolve the mystery.
authors.affiliation: Massachusetts Eye Research and Surgery Institution (MERSI), Cambridge, Massachusetts 02412, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Mehta
authors.forename: Mark
authors.initials: M
authors.lastname: Dacey
authors.forename: C
authors.initials: C
authors.lastname: Stephen Foster
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003229:Conjunctival Diseases / Q000150:complications* / Q000188:drug therapy; D003231:Conjunctivitis / Q000209:etiology*; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008499:Medical Records; D008875:Middle Aged; D009336:Necrosis; D010392:Pemphigus / Q000150:complications* / Q000188:drug therapy; D012008:Recurrence; D012189:Retrospective Studies; D015423:Scleritis / Q000209:etiology* / Q000473:pathology; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir