title: Herpes Simplex Keratitis in Rheumatoid Arthritis Patients.
abstract: OBJECTIVE
  To describe a series of 5 patients with herpes simplex virus keratitis (HSK) and rheumatoid arthritis (RA) under immunosuppressive treatment.
  
  
  METHODS
  Retrospective study. Detailed data were obtained regarding symptoms and signs at the initial evaluation, treatment, microbiological diagnostic tests, evolution, and outcomes.
  
  
  RESULTS
  Five patients with HSK and RA were identified. Bilateral involvement occurred in 2 patients (40%). Epithelial keratitis was diagnosed in 5 eyes. Three eyes showed severe melting with eye perforation. Gram-positive bacterial co-infections were common in the group with stromal keratitis. We did not find differences in the evolution of the disease based on anti-rheumatoid treatment.
  
  
  CONCLUSIONS
  The characteristics of HSK in patients with RA differed from HSK in immunocompetent patients. The stromal keratitis cases were very aggressive and difficult to manage, with perforation and gram-positive bacterial co-infection as frequently associated conditions. Prophylactic therapy at standard doses was unsuccessful to avoid recurrences.
authors.affiliation: a Department of Ophthalmology , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain .
authors.forename: Paula
authors.initials: P
authors.lastname: Larrañaga Fragoso
authors.affiliation: a Department of Ophthalmology , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain .
authors.forename: Ana
authors.initials: A
authors.lastname: Boto de Los Bueis
authors.affiliation: a Department of Ophthalmology , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain .
authors.forename: Luciano
authors.initials: L
authors.lastname: Bravo Ljubetic
authors.affiliation: a Department of Ophthalmology , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain .
authors.forename: Almudena
authors.initials: A
authors.lastname: Del Hierro Zarzuelo
authors.affiliation: b Department of Microbiology , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain , and.
authors.forename: M Pilar
authors.initials: MP
authors.lastname: Romero Gómez
authors.affiliation: c Department of Infectious Disease , IdiPAZ - Hospital Universitario La Paz , Madrid , Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Mora Rillo
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D003319:Corneal Stroma / Q000473:pathology / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D018259:Herpesvirus 1, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016849:Keratitis, Herpetic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000212:Acyclovir
keywords: Herpes simplex keratitis; peripheral ulcerative keratitis; polymerase chain reaction; rheumathoid arthritis; stromal keratitis