Skip to main content
SpringerLink
Log in

Intravenous acyclovir treatment for extensive herpetic keratitis in a liver transplant patient

  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Herpetic infection is a common complication among immune suppressed patients following heart, kidney and bone marrow transplantations,in leukemia patients, in AIDS patients, and during treatment with cytotoxic drugs. In the cases described in the literature, oral acyclovir was recommended as a treatment for the acute infection, as well as for prophylaxis. Intravenous acyclovir is not a routine treatment for herpetic keratitis, but is recommended for cases of insufficient clinical response to oral treatment, and defective absorption of acyclovir by the gastrointestinal tract. We present a patient who underwent 4 liver transplantations,was treated regularly with immunosuppressive drugs, and who developed extensive herpetic keratitits. The keratitis was resistant to both topical ointment and oral acyclovir treatment. Recovery was only achieved following the intravenous administration of acyclovir. We recommend intravenous acyclovir treatment at avery early stage for immune suppressed patients with extensive herpes simplex keratitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hirst LW, Jabs DA, Tutschka PJ, Green WR, Santos GN. The eye in bone marrow transplantation. Arch Ophthalmol 1983; 101: 580–4.

    PubMed  CAS  Google Scholar 

  2. Jack MK, Hicks JD. Ocular complications in high dose chemoradiotherapy and marrow transplantation. Ann Ophthalmol 1981; 13: 709–11.

    PubMed  CAS  Google Scholar 

  3. Schubert MM, Peterson DE, Flournoy N, Meyers JD, Truelove EL. Oral and pharyngeal herpes simplex virus infection after allogeneic bone marrow transplantation: analysis of factors associated with infection. Oral Surg Oral Med Oral Pathol 1990; 70: 286–93.

    Article  PubMed  CAS  Google Scholar 

  4. Korsager B, Spenser ES, Mordhobt CH, Anderson HZ. Herpesvirus hominis infections in renal transplant recipients. Scand J Infect Dis 1975; 7: 11–19.

    PubMed  CAS  Google Scholar 

  5. Pass RF, Whitley RJ, Whelchel JD, Diethelm AG, Reynolds DW, Alford CA. Identification of patients with increased risk of infection with herpes simplex virus after renal transplantation. J Infec Dis 1979; 140: 487–92.

    CAS  Google Scholar 

  6. Howcroft MJ, Breslin CW. Herpes simplex keratitis in renal transplant recipients. Can Med Assoc J 1981; 124: 292–4.

    PubMed  CAS  Google Scholar 

  7. Jirasiritham S, Sumethkul V, Chiewsilp P, Gojaseni P. Prevention of recurrent herpes infection after renal transplantation by low-dose oral acyclovir. Transplant Proc 1994; 26: 2125–6.

    PubMed  CAS  Google Scholar 

  8. Hancke E, Schleibner S, Schneeberger H, Illner WD, Land W. Infections following kidney transplantation under threefold or fourfold immunosuppressive treatment. Dtsch Med Wochenschr 1990; 115: 443–6.

    Article  PubMed  CAS  Google Scholar 

  9. Rand KH, Rosmussen LE, Pollard RB, Arvin A, Merigan TC. Cellular immunity and herpesvirus infections in cardiactransplant patients. N Engl J Med 1976; 296: 1372–7.

    Article  Google Scholar 

  10. Delfino M, Frasca M, Makk E. Infections in heart transplantations. Recenti Prog Med 1994; 85: 467–70.

    PubMed  CAS  Google Scholar 

  11. Kramer MR, Marshall SE, Starnes VA, Gamberg P, Amitai Z, Theodore J. Infectious complications in heart-lung transplantation. Analysis of 200 episodes. Arch Intern Med 1993; 153: 2010–6.

    Article  PubMed  CAS  Google Scholar 

  12. Keating MR, Wilhelm MP, Walker RC. Strategies for prevention of infection after cardiac transplantation. Mayo Clin Proc 1992; 67: 676–84.

    PubMed  CAS  Google Scholar 

  13. Smyth RL, Higenbottam TW, Scott JP, Wreghitt TG, Stewart S, Clelland CA, McGoldrick JP, Wallwork J. Herpes simplex virus infection in heart-lung transplant recipients. Transplantation 1990; 49: 735–9.

    PubMed  CAS  Google Scholar 

  14. Horsmans Y, Lerut J, Donataccio M, Otte JB, Geubel AP. Viral infections and liver transplantation. Acta Gastroenterol Belg 1994; 57: 188–93.

    PubMed  CAS  Google Scholar 

  15. Burke EM, Karp DL, Wu TC, Corio RL. Atypical oral presentation of herpes simplex virus infection in a patient after orthotopic liver transplantation. Eur Arch Otorhinolaryngol 1994; 251: 301–3.

    Article  PubMed  CAS  Google Scholar 

  16. Abeck D, Brandt O, Weichenthal M, Kowalzick L, Mensing H. Chronic mucocutaneous herpes simplex infection. Occurrence within the scope of liver-induced immunodeficiency. Hautarzt 1993; 44: 670–3.

    PubMed  CAS  Google Scholar 

  17. Rayani SA, Nimmo CJ, Frighetto L, Martinusen SM, Nickoloff DM, Reece DE, Jewesson PJ. Implementation and evaluation of a standardized herpes simplex virus prophylaxis protocol on a leukemia/bone marrow transplant unit. Ann Pharmacother 1994; 28: 852–6.

    PubMed  CAS  Google Scholar 

  18. Carrega G, Castagnola E, Canessa A, Argenta P, Haupt R, Dini G, Garaventa A. Herpes simplex virus and oral mucosities in children with cancer. Support Care Cancer 1994; 2: 266–9.

    Article  PubMed  CAS  Google Scholar 

  19. Shuler JD, Engstrom RE, Holland GN. External ocular disease and anterior segment disorders associated with AIDS. Int Ophthalmol Clin 1989; 29: 98–104.

    PubMed  CAS  Google Scholar 

  20. Eversole LR. Viral infections of the head and neck among HIV-seropositive patients. Oral Surg Oral Med Oral Pathol 1992; 73: 155–63.

    Article  PubMed  CAS  Google Scholar 

  21. Munoz A, Schrager LK, Bacellar H, Speizer I, Vermund SH, Detels R, Saah AJ, Kingsley LA, Seminara D, Phair JP. Trends in the incidence of outcomes defining acquired immunodeficiency syndrome (AIDS) in the Multicenter AIDS Cohort Study: 1985–1991. Am J Epidemiol 1993; 137: 423–38.

    PubMed  CAS  Google Scholar 

  22. Safrin S, Ashley R, Houlihan C, Cusick PS, Mills J. Clinical and serologic features of herpes simplex virus infection in patients with AIDS. AIDS 1991; 5: 1107–10.

    PubMed  CAS  Google Scholar 

  23. Haruta Y, Rootman DS, Xie L, Kiritoshi A, Hill JM. Recurrent HSV-1 corneal epithelial lesions induced by cyclophosphamide and dexamethasone in latency infected rabbits. Invest Ophthalmol Vis Sci 1989; 30: 371–6.

    PubMed  CAS  Google Scholar 

  24. Meyers-Elliott RH, Chitjian PA, Billups CB. Effects of cyclosporine A on clinical and immunological parameters in herpes simplex keratitis. Invest Ophthalmol Vis Sci 1987; 28: 1170–80.

    PubMed  CAS  Google Scholar 

  25. Boisjoly HM, Woog JJ, Pavan-Langston D, Park N. Prophylactic topical cyclosporine in experimental herpetic stromal keratitis. Arch Ophthalmol 1984; 102: 1804–7.

    PubMed  CAS  Google Scholar 

  26. Easterbrook M, Wilkie J, Coleman V, Dawson CR. The effect of topical corticosteroidson the susceptibility of immune animals to reinoculation with herpes simplex. Invest Ophthalmol 1973; 12: 181–9.

    PubMed  CAS  Google Scholar 

  27. Uemoto S, Tanaka F, Fujita S, Sano K, Shirahase I, Kato H, Yamamoto E, Inomata Y, Ozawa K. Infectious complications in living related liver transplantation. J Pediatr Surg 1994; 29: 514–7.

    Article  PubMed  CAS  Google Scholar 

  28. Wade J. Management of herpes in immunocompromised patients. Cannes Meeting, France, 8 Nov. 1991.

  29. Meyers JD, Wade JC, Mitchell CD. Multicenter collaborative trial of intravenous acyclovir for treatment of mucocutaneous herpes simplex infection in the immunocompromised host. Am J Med 1982; 73: 229–35.

    PubMed  CAS  Google Scholar 

  30. Kremer I, Wagner A, Shmuel D, Yussim A, Shapira Z. Herpes simplex keratitis in renal transplant patients. Br J Ophthalmol 1991; 75: 94–6.

    PubMed  CAS  Google Scholar 

  31. Wade JC, McLaren C, Meyers JD. Frequency and significance of acyclovir-resistent herpes simplex virus isolated from marrow transplant patients receiving multiple course of treatment with acyclovir. J Infect Dis 1983; 148: 1077–82.

    PubMed  CAS  Google Scholar 

  32. Englund JA, Zimmerman ME, Swierkosz EM, Goodman JL, Scholl DR, Balfour HH. Herpes simplex virus resistent to acyclovir. A study in a tertiary care center. Ann Int Med 1990; 112: 416–22.

    PubMed  CAS  Google Scholar 

  33. Tang IT, Shepp DH. Herpes simplex virus infection in cancer patients: prevention and treatment. Oncology Huntingt 1992; 6: 101–6, 109–10.

    PubMed  CAS  Google Scholar 

  34. Field AK, Biron KK. ‘The end of innocence’ revisited: resistance of herpesviruses to antiviral drugs. Clin Microbiol Rev 1994; 7: 1–13.

    PubMed  CAS  Google Scholar 

  35. Koziel MJ, Walker BD. Viruses, chemotherapy and immunity. Parasitology 1992; 105: S85–92.

    Article  PubMed  Google Scholar 

  36. Fardeau C, Langlois M, Nugier F, Asselot C, Aymard M, Denis J. Cross-resistances to antiviral drugs of IUdR-resistant HSV1 in rabbit keratitis and in vitro. Cornea 1993; 12: 19–24.

    PubMed  CAS  Google Scholar 

  37. Sonkin PL, Baratz KH, Frothingham R, Cobo LM. Acyclovirresistant herpes simplex virus keratouveitis after penetrating keratoplasty. Ophthalmology 1992; 99: 1805–8.

    PubMed  CAS  Google Scholar 

  38. Soriano JM, Funk J, Janknecht P, Matz B. Recurrent herpetic keratitis during topical acyclovir application. Eur J Ophthalmol 1992; 2: 155–7.

    PubMed  CAS  Google Scholar 

  39. Fardeau C, Langlois M, Mathys B, Rafales P, Nugier F, Godard V, Aymard M, Denis J. Emergence of cross-resistant herpes simplex virus following topical drug therapy in rabbit keratitis. Curr Eye Res 1991; 10: 151–8.

    PubMed  Google Scholar 

  40. Whittum Hudson JA, Merges MJ, Field HJ. Immunogenicity versus pathogenicity after anterior chamber inoculation of an acyclovir-induced double mutant of HSV-1. Curr Eye Res 1987; 6: 1459–70.

    PubMed  CAS  Google Scholar 

  41. Collins P. Mechanisms of herpes virus resistance. Ann Med 1993; 25: 441–5.

    PubMed  CAS  Google Scholar 

  42. Collins P, Ellis MN. Sensitivity monitoring of clinical isolates of herpes simplex virus to acyclovir. J Med Virol 1993; Suppl 1: 58–66.

  43. Stroop WG, Banks MC, Qavi H, Chodosh J, Brown SM. A thymidine kinase deficient HSV-2 strain causes acute keratitis and establishes trigeminal ganglionic latency, but poorly reactivates in vivo. J Med Virol 1994; 43: 297–309.

    PubMed  CAS  Google Scholar 

  44. Ficarra G, Chiodo M, Morfini M, Longo G, Orsi A, Piluso S, Rafanelli D. Oral lesions among HIV-infected hemophiliacs. A study of 54 patients. Haematologica 1994; 79: 148–53.

    PubMed  CAS  Google Scholar 

  45. Matthews JT, Terry BJ, Field AK. The structure and function of the HSV DNA replication proteins: defining novel antiviral targets. Antiviral Res 1993; 20: 89–114.

    Article  PubMed  CAS  Google Scholar 

  46. Dorsky DI, Plourde C. Resistance to antiviral inhibitors caused by the mutation S889A in the highly-conserved 885-GDTDS motif of the herpes simplex virus type 1 DNA polymerase. Virology 1993; 195: 831–5.

    Article  PubMed  CAS  Google Scholar 

  47. Pelosi E, Hicks KA, Sacks SL, Coen DM. Heterogeneity of a herpes simplex virus clinical isolate exhibiting resistance to acyclovir and foscarnet. Adv Exp Med Biol 1992; 312: 151–8.

    PubMed  CAS  Google Scholar 

  48. Hwang CB, Ruffner KL, Coen DM. A point mutation within a distinct conserved region of the herpes simplex virus DNA polymerase gene confers drug resistance. J Virol 1992; 66: 1774–6.

    PubMed  CAS  Google Scholar 

  49. Scieux C, Bianchi A. Resistance of herpes simplex viruses to antiviral drugs. TO: La resistance des virus herpes simplex aux antiviraux. Pathol Biol Paris 1993; 41: 172–7.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Soroka Medical Center, Ben Gurion University, P.O. Box 151, Beer Sheva, 84101, Israel

    Tzafrir Oshry & Tova Lifshitz

Authors
  1. Tzafrir Oshry
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tova Lifshitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Oshry, T., Lifshitz, T. Intravenous acyclovir treatment for extensive herpetic keratitis in a liver transplant patient. Int Ophthalmol 21, 265–268 (1997). https://doi.org/10.1023/A:1006057204609

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1006057204609

Search

Navigation