Anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis associated with herpes zoster

AIM: To analyze etiopathogenesis, clinical features, and a treatment algorithm for acute anterior diffuse scleritis, map-like corneal ulcer, and hypopyon anterior uveitis in order to increase medical awareness of herpes zoster in children. RESULTS: Long-term exposure to rapid temperature changes contributed to varicella-zoster virus (VZV) reactivation in a child leading to herpes zoster rarely occurring in children, onset of anterior diffuse scleritis and hypopyon anterior uveitis. Corticosteroid therapy without causal treatment led to herpes virus reactivation in the patient’s cornea which contributed to herpes corneal ulcer. CONCLUSION: Etiopathogenesis features were analyzed, characteristic clinical symptoms of anterior diffuse scleritis, herpes corneal ulcer, and hypopyon anterior uveitis caused by varicella-zoster virus (VZV) reactivation were described. Reactivation led to herpes zoster with skin eruption and herpes zoster ophthalmicus, such as injury of the ophthalmic branch of the trigeminal nerve without extraocular (skin) symptoms of herpes infection. The VZV etiological role was established based on high titers of anti-VZV IgG antibodies, the presence of anti-VZV-gE IgG antibodies (markers of active viral replication), and the efficacy of anti-herpes therapy. The described clinical symptoms of combined ophthalmic pathology contribute to the early diagnosis of ocular herpes for timely antiviral herpes therapy to prevent chronic disease and complications and to preserve and/or recover visual acuity.