Concurrent Detection of Varicella-Zoster Virus and Human Herpesvirus-6 in Corneal Endotheliitis: A Case Report

TL;DR

A 75-year-old man with corneal endotheliitis had both VZV and HHV-6 detected in his eye, and recovered after combined antiviral treatment.

Contribution

First reported case of concurrent VZV and HHV-6 in viral corneal endotheliitis with successful treatment.

Findings

Patient showed complete clinical recovery after combined antiviral therapy targeting both VZV and HHV-6.

Endothelial cell count remained reduced at 917 cells/mm² at three months, indicating permanent damage.

No recurrence was observed during one year of follow-up.

Abstract

Viral corneal endotheliitis is predominantly caused by herpes viruses, with cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella-zoster virus (VZV) being the most commonly implicated pathogens. The simultaneous detection of multiple herpes viruses in aqueous humor by polymerase chain reaction (PCR) is a rare phenomenon that presents diagnostic and therapeutic challenges. We report a unique case of a 75-year-old male patient who developed unilateral corneal endotheliitis with concurrent detection of VZV and human herpesvirus-6 (HHV-6) in aqueous humor PCR. The patient had a history of herpes zoster ophthalmicus with conjunctivitis six months prior to presentation. Initial treatment with acyclovir ointment and betamethasone drops was supplemented with ganciclovir drops targeting HHV-6. The patient demonstrated complete clinical recovery with viral clearance at two months, though endothelial cell count remained reduced at 917 cells/mm² at three months, reflecting permanent endothelial damage. No recurrence was observed during one year of follow-up. This, to the best of our knowledge, represents the first reported case of concurrent VZV and HHV-6 detection in viral corneal endotheliitis. The successful therapeutic response to combined antiviral therapy targeting both viral pathogens suggests that comprehensive herpes virus screening and tailored antiviral treatment may be crucial for optimal outcomes. Digital PCR technology enables precise viral identification, facilitating evidence-based antiviral selection in complex cases.

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