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Letter to the editor: Herpes zoster keratouveitis with hypopyon and hyphema

 Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq

Date of Submission03-Apr-2020
Date of Acceptance28-May-2020
Date of Web Publication17-Jul-2020

Correspondence Address:
Mahmood Dhahir Al-Mendalawi,
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P.O. Box 55302, Baghdad Post Office, Baghdad
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjo.tjo_34_20

How to cite this URL:
Al-Mendalawi MD. Letter to the editor: Herpes zoster keratouveitis with hypopyon and hyphema. Taiwan J Ophthalmol [Epub ahead of print] [cited 2021 Mar 3]. Available from: https://www.e-tjo.org/preprintarticle.asp?id=290026

Dear Editor,

In January – March 2020 issue of the Taiwan Journal of Ophthalmology, Katherine et al.[1] reported herpes zoster keratouveitis (HZK) with hypopyon and hyphema in two Malaysian patients. The authors described nicely the clinical presentation, management plan, and outcome. The rarity of condition and escalating clinical course culminating in poor vision should alert the authors to take into consideration impaired immunity, particularly infection with human immunodeficiency virus (HIV). It is explicit that due to defective immune system, HIV-infected individuals are at increased susceptibility to various viral infections compared to the individuals with intact immune system. Truly, herpes zoster ophthalmicus (HZO) has been reported in 2.7% of HIV-infected patients.[2] The disease spectrum of HZO in such patients tends to be generalized, more severe, and less amenable to therapy as compared with HIV-negative patients.[3] Infection with HIV is an evolving health problem in Malaysia. The published data pointed out that the national adult HIV prevalence rate was estimated at 0.4% in 2018.[4] I presume that HIV infection ought to be seriously considered in the two cases in question. Katherine et al.[1] did not consider HIV infection as regrettably, they did not address HIV status of the studied two patients. I assume that the diagnostic battery of HIV detection in terms of employing fourth generation antigen/antibody immunoassays and estimating viral overload and CD4 lymphocyte count would have solicited. If that battery was to show HIV positivity, the two cases in question could be explicitly regarded the novel case reports of HZK with hypopyon and hyphema in HIV-positive patients in the literature.

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Conflicts of interest

The author declares that there are no conflicts of interests of this paper.

  References Top

Katherine SB, Ngim YS, Juliana J, Ramli N. Herpes zoster keratouveitis with hypopyon and hyphema. Taiwan J Ophthalmol 2020;10:54-7.  Back to cited text no. 1
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Osahon AI, Onunu AN. Ocular disorders in patients infected with the human immunodeficiency virus at the University of Benin Teaching Hospital, Benin City, Nigeria. Niger J Clin Pract 2007;10:283-6.  Back to cited text no. 2
[PUBMED]  [Full text]  
Gupta N, Sachdev R, Sinha R, Titiyal JS, Tandon R. Herpes zoster ophthalmicus: Disease spectrum in young adults. Middle East Afr J Ophthalmol 2011;18:178-82.  Back to cited text no. 3
[PUBMED]  [Full text]  
UNAIDS. Country Factsheets. MALAYSIA 2018. HIV and AIDS Estimates. Available from: https://www.unaids.org/en/regionscountries/countries/malaysia. [Last accessed on 2020 Apr 02].  Back to cited text no. 4


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