| Presentation preference | Poster presentation |
| Title | Persistent Ocular Herpes Zoster Confirmed by PCR in a Young Patient with Multiple Sclerosis on Dimethyl Fumarate Therapy |
| Accept poster if oral is not possible ? | Yes |
| Purpose | To report the case of a patient with multiple sclerosis (MS) on dimethyl fumarate (DMF) treatment who developed herpes zoster ophthalmicus (HZO), leading to recurrent stromal keratitis and uveitis, and to describe the cessation of recurrences following the administration of the Shingrix vaccine. |
| Methods | Case Report |
| Results | A 38-year-old female with a history of MS and optic neuritis, treated with DMF, presented with HZO. The patient was managed with high dose valaciclovir (3g daily for 6 months), topical corticosteroids, and losartan eye drops, which improved stromal opacities. Despite ongoing antiviral and steroid therapy, the patient experienced multiple recurrences of keratouveitis and stromal scarring. Ocular PCR testing six months after the initial manifestation was positive for herpes type 3. After stabilization of the acute episodes, the recombinant zoster vaccine (RZV, Shingrix) was administered. Post-vaccination, the patient reported no further recurrences of herpes zoster or its ocular manifestations. The use of losartan eye drops was effective in reducing corneal stromal opacities. |
| Conclusion | This case underscores the necessity of vaccination with the recombinant zoster vaccine (RZV) in immunosuppressed patients. The American Academy of Ophthalmology recommend RZV for immunocompromised adults aged 18 and older, affirming its critical role in protecting this vulnerable population. Additionally, the use of losartan eye drops has proven beneficial in managing stromal keratitis in such complex cases. Moreover, there is a need for further studies to determine the optimal timing and safety of Shingrix administration specifically within the field of ophthalmology. |
| Conflict of interest | Yes |
| Details of conflicting interests | I declare that I am a speaker for GSK, the manufacturer of the Shingrix vaccine. |
1
| Last name | PEIXOTO DOS SANTOS FINAMOR |
| Initials of first name(s) | L |
| Department | Ophthalmology department - Federal University of São Paulo ; Clínica Moacir Cunha/grupo Fleury |
| City | São Paulo |
| Country | Brazil |
2
| Last name | Cunha |
| Initials of first name(s) | L |
| Department | Clinica de Olhos Dr. Moacir Cunha/Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
3
| Last name | Lazary |
| Initials of first name(s) | C |
| Department | Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
4
| Last name | Andrade |
| Initials of first name(s) | G |
| Department | Clínica de Olhos Dr. Moacir Cunha/Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
5
| Last name | Zanetti |
| Initials of first name(s) | B |
| Department | Clínica de Olhos Dr. Moacir Cunha/Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
6
| Last name | Granato |
| Initials of first name(s) | C |
| Department | Department of Infectious Disease UNIFESP; Grupo Fleury |
| City | São Paulo |
| Country | Brazil |
