A herpetic keratitis determined immunosuppressed patient with atypical presentation

We aimed to report a case of atypical herpetic keratitis that developed after renal transplantation. A 48-year-old woman presented with redness, photophobia, tearing, foreign body, sensation and decreased vision in the left eye. The patient had undergone renal transplantation 6 months ago, was being treated by systemic immunosuppressants. (Cyclosporine A, mycophenolate mofetil and prednisolone acetate). Examination revealed Dellen ulcers and dendriform lesions which were parallel to the limbus, extending from the temporal area upper-quadrant to the nasal area. Based on the clinical findings, atypical herpes simplex virus keratitis (HSVK) was suspected. The subsequent corneal scraping and real-time polymerase chain reaction (PCR) analysis yielded a positive result for Herpes Simplex Virus Type 1 (HSV-1) genome. Topical and systemic acyclovir therapies were prescribed. One week later, the dendriform lesions showed significant improvement and healed completely within 3 weeks. In immunocompromised patients, herpetic keratitis can appear in unusual presentations. Patient on immunosuppressive treatment with suspected herpetic keratitis, early topical and systemic antiviral therapy may prevent permanent vision loss and sequelae.