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22-year-old patient presents with corneal lesions

A young mother presented with herpes simplex keratitis triggered by lactation-aggravated malnutrition and anaemia

22 Mar 2019 by Selina Powell

BMJ Case Reports authors have described the case of 22-year-old patient who required a corneal transplantation in her right eye after herpes simplex keratitis was triggered by breastfeeding.

The woman presented to a hospital in New Delhi, India with a sudden loss of vision following a five-day history of redness, pain and photophobia in both eyes.

She was breastfeeding her two-month-old baby at the time of the onset of the symptoms.

Vision in the patient’s left eye was 6/12 and was limited to hand movements in her right eye. A central corneal melt was observed in her right eye

Clinicians determined that in the absence of ocular trauma or long-standing ocular problems, the patient was likely to have viral keratitis.

This was supported by observing decreased corneal sensations in both eyes and the characteristic dendritic pattern of an ulcer in the patient’s left eye.

The patient was treated with antiviral medication and a therapeutic penetrating keratoplasty in her right eye.

At three months follow up, best corrected visual acuity in her right eye was 6/12 while her left eye responded “dramatically” to medical management from day one onwards.

The authors observed: “We believe that a previous undiagnosed primary infection in our patient could have been reactivated by body’s decreased ability to battle infections from lactation aggravated malnutrition and anaemia.”

Image credit: UNICEF Ukraine/Flickr

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