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2016 Agenda and Abstracts | < Previous | Next > 2016 OMIG Abstract 21 Herpes Simplex Keratitis in a Healthy 4-Week-Old Purpose: We will present the clinical findings and the management of a case of HSV keratitis in a neonate. Methods: A 4-week-old, the first child to her mother, developed a red right eye, mucopurulent discharge and corneal haze 3 days after birth. The patient’s mother has a history of herpes labialis. She has no history of genital herpes. There were no herpes infections during her pregnancy. The baby was born via an uneventful vaginal delivery. There was no evidence of vaginal sores at the time of delivery. Shortly thereafter, the baby was seen by a pediatrician, who prescribed antibiotic ointment. Results: At 30 days of age, the baby was referred to a pediatric ophthalmologist who began treatment for HSV. We examined the baby at 40 days of age. She had a 5mm dendrite and 3+ corneal stromal haze. Treatment consisting of oral acyclovir suspension QID and Ganciclovir gel 6 times/day was used. Exam by a pediatric infectious disease specialist, noted an asymptomatic baby without systemic disease. Serologies were performed; on the mother they demonstrated elevated HSV IgG and negative IgM. On the baby, both IgM and IgG were elevated, consistent with an acute HSV infection. The baby was re-examined at 9 weeks of age. The dendrite had disappeared. A 2mm nummular anterior stromal scar, out of the visual axis remained. Conclusion: This case demonstrates that acquired herpes virus keratitis can occur in a neonate in the absence of any systemic symptoms. Inoculation of the baby is presumably secondary to asymptomatic shedding of the HSV virus in the mother’s vaginal tract at the time of delivery or from her oral mucosa afterwards. These children should be carefully monitored and evaluated for any systemic disease. If necessary, the child should have a spinal tap to rule out any neurologic findings. Oral acyclovir is required as prophylaxis for at least 6 to 12 months to prevent spread of the disease to other organs in the body. N 2016
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