A CASE OF MULTIPLE PARALLEL-LINE ENDOTHELIITIS (MPLE): EVIDENCE FOR THE LINK TO HERPES SIMPLEX

Title A CASE OF MULTIPLE PARALLEL-LINE ENDOTHELIITIS (MPLE): EVIDENCE FOR THE LINK TO HERPES SIMPLEX
Author, Co-Author Crystal Lewandowski
Topic
Year
2013
Day
Program Number
R02013105
Room
Room 6C
Affiliation
Abstract BACKGROUND:
We report a case of MPLE with evidence supporting the link to HSV, a 56 yo male with h/o HSV presenting with unilateral linear keratic precipitates.

CASE REPORT(S):
1. Case Hx
56 y/o male c/o irritation, tearing, pain upon waking OS; reports "I scratched my eye with my artificial tear bottle". H/o dry eye, trichiasis, and herpes genitalis. Patient not on medications.

2. Pertinent Findings
DVA (sc) is 20/15 OD, OS. Slit lamp exam OD: MGD, OS: MGD, 1+ injection nasally, no staining, fine KPs forming 5 horizontal parallel-lines, mild stromal edema, 1+ AC rxn. IOP 15,15 @4:09pm. DFE unremarkable OU. Physical presentation unremarkable.

3. Ddx
Leading (from CC): K abrasion, K sicca, misdirected lash, RCE
DDX (from SLE): HSK, dystrophy

4. Dx/Discussion
Dx: Endotheliitis OS, presumed etiology HSV
The endothelium is the primary site of inflammation. Virus shedding into anterior chamber induces ACAID against viral antigens, suppressing cell mediated immunity and allowing HSV proliferation in the endothelium.

Unique features:
1. HSK presenting with endothelial involvement (usually epithelial).
2. Dissimilar from common endotheliitis descriptions (linear, sectoral, disciform, diffuse).
3. Two published case reports on MPLE:
One case associates MPLE with HSV; main sx of blur (not irritation).
Three other reported cases of MPLE thought to be idiopathic inflammation; not linked to HSV due to lack of detection in AC.

5. Tx/Management
Significant improvement 48hrs after initiation of Valtrex 500mg TID, Pred Forte 1% 1 gtt q2hr OS, cyclopentolate 2% 1 gtt q4hr OS. Complete resolution after 1 wk.

6. Literature Review
1. Suzuki T, Ohashi Y. Corneal endotheliitis. Seminars in Ophthalmology 2008;23-4:235-240.
2. Hori Y, Mauda N. Three cases of idiopathic "multiple parallel line" endotheliitis. Cornea 2008;27:103-6.
3. Oxley L, Carrim Z. Multiple parallel line endotheliitis - a form of herpes simplex keratitis? Optom Vis Sci 2012;89(3)E353-5.

CONCLUSIONS:
MPLE may represent a distinct variation of HSK. Due to risk of permanent vision loss, accurate diagnosis and prompt treatment are vital. Refer if no improvement after several days of treatment.
Affiliation of Co-Authors
Outline