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Dendritic Keratitis Caused by an Acyclovir-Resistant Herpes Simplex Virus With Frameshift Mutation

Zhang, Wei MD, PhD*; Suzuki, Takashi MD, PhD*; Shiraishi, Atsushi MD, PhD*; Shimamura, Ichiroh MD*; Inoue, Yoshitsugu MD, PhD; Ohashi, Yuichi MD, PhD*

doi: 10.1097/01.ico.0000240081.19635.db
Case Report

Purpose: To report a case of acyclovir-resistant herpes simplex virus (HSV) keratitis after long-term, inconsistent use of topical acyclovir and fluorometholone.

Methods: A 70-year-old man with dendritic keratitis caused by an acyclovir-resistant HSV strain was examined. The 50% inhibitory concentration of different antiviral agents against the isolated virus and the DNA sequence of viral thymidine kinase were determined.

Results: The 50% inhibitory concentration of acyclovir and trifluorothymidine for the isolated HSV strain was 13.75 and 0.28 μg/mL, respectively, indicating that the virus was resistant to acyclovir. DNA sequencing of the viral thymidine kinase revealed that this virus had a frameshift mutant with a G insertion in the 7Gs homopolymer. Topical trifluorothymidine was effective, and the epithelial lesion was completely resolved within 2 weeks.

Conclusion: A typical form of dendritic keratitis was caused by an acyclovir-resistant HSV with frameshift mutation in a 7Gs homopolymer region.

From the *Department of Ophthalmology, Ehime University School of Medicine, Shitsukawa, Toon-City, Ehime, Japan; and the †Division of Ophthalmology and Visual Science, Faculty of Medicine, Tottori University, Yonago, Japan.

Received for publication April 17, 2006; accepted for publication July 2, 2006.

Reprints: Wei Zhang, Department of Ophthalmology, Ehime University School of Medicine, Shitsukawa, Toon-City, Ehime 791-0295, Japan (e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.