Non-healing corneal ulcer and severe IOP elevation following MPOX disease: Diagnostic and therapeutic challenges
Purpose
We report the case of a patient with monkeypox disease (MPOX) who developed ocular complaints (unilateral corneal ulcer, uveitis and severe IOP elevation). This case report describes the treatment and outcomes of ocular pox lesions with tecovirimat.
Methods
A 52 yo male presented to the Emergency Department of our Clinic, complaining of pain in the right eye, photophobia, blurred vision and foreign body sensation. Slit lamp exam disclosed conjunctival injection and an extensive corneal ulcer in combination with anterior uveitis and severe ocular hypertension (45mmHg). Fundus examination was unremarkable. Herpes was suspected and he was put on valacyclovir and acetazolamide without any therapeutic effect whatsoever. On questioning the patient disclosed a recent hospitalization for MPOX and a positive history of HIV. The washout from the affected cornea was PCR positive for MPOX virus. The antiviral treatment for herpes was stopped and oral tecovirimat was initiated with clinical improvement and regression of the corneal lesion. The resolution of the inflammation was accompanied by a gradual decrease in IOP.
Results
Corneal ulceration and anterior uveitis are rare complications of monkeypox virus infection. Although the disease is generally self-limiting, the administration of specific antiviral therapy can be an effective intervention in monkeypox keratitis and other ocular manifestations of the virus.
Conclusion
This is the first case of a MPOX patient reported with uveitis and ocular hypertension in Greece. The antiviral agent tecovirimat may be effective against ocular manifestations with high risk of visual loss.
Conflict of interest
No
Authors 1
Last name
TOUMANIDOU
Initials of first name(s)
V
Department
University of Thessaly, Department of Ophthalmology, Greece
City
LARISSA
Country
Greece
Authors 2
Last name
MITSIOS
Initials of first name(s)
A
Department
University of Thessaly, Department of Ophthalmology, Greece
City
LARISSA
Country
Greece
Authors 3
Last name
SAPOUNAS
Initials of first name(s)
S
Department
National Public Health Organization (NPHO)
City
ATHENS
Country
Greece
Authors 4
Last name
PAVLAKI
Initials of first name(s)
M
Department
University of Thessaly, Department of Ophthalmology, Greece
City
LARISSA
Country
Greece
Authors 5
Last name
KOUVALAKIS
Initials of first name(s)
A
Department
University of Thessaly, Department of Ophthalmology, Greece
City
LARISSA
Country
Greece
Authors 6
Last name
ANDROUDI
Initials of first name(s)
S
Department
University of Thessaly, Department of Ophthalmology, Greece
City
LARISSA
Country
Greece
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