title: Bilateral herpes simplex keratitis presenting as peripheral ulcerative keratitis.
abstract: OBJECTIVE
  To report a case of bilateral Herpes simplex keratitis (HSK) masquerading as peripheral ulcerative keratitis (PUK).
  
  
  METHODS
  A case of a 47-year-old female complaining of painful red eyes with a history of arthritis and anterior uveitis attacks with positive antinuclear antibodies (ANA). Biomicroscopy revealed PUK, stromal infiltrations and bilateral central corneal epithelial erosions. Slit-lamp examination disclosed +3 anterior chamber cells in both eyes.
  
  
  RESULTS
  Blood testing was positive for ANA. Herpes simplex virus (HSV) antigen was identified in both eyes using polymerase chain reaction (PCR). The management included topical prednisolone and acyclovir, as well as systemic valacyclovir. Improvement of epithelial corneal defects, PUK, and visual acuity was achieved gradually during the follow-up period.
  
  
  CONCLUSIONS
  Bilateral herpetic keratitis presenting as PUK is an extremely rare manifestation of herpetic disease. PUK can pose a diagnostic dilemma in cases with immune system dysregulation. Excluding infectious agents is mandatory for appropriate treatment.
authors.affiliation: Department of Ophthalmology, Aristotle University, Thessaloniki, Greece. praidou2003@yahoo.co.uk
authors.forename: Anna
authors.initials: A
authors.lastname: Praidou
authors.forename: Sofia
authors.initials: S
authors.lastname: Androudi
authors.forename: Evgenia
authors.initials: E
authors.lastname: Kanonidou
authors.forename: Vassilios
authors.initials: V
authors.lastname: Konidaris
authors.forename: Alexandros
authors.initials: A
authors.lastname: Alexandridis
authors.forename: Periklis
authors.initials: P
authors.lastname: Brazitikos
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000956:Antigens, Viral / Q000235:genetics; D000998:Antiviral Agents / Q000627:therapeutic use; D003320:Corneal Ulcer / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016849:Keratitis, Herpetic / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011239:Prednisolone / Q000627:therapeutic use; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D005938:Glucocorticoids; D011239:Prednisolone; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir