Abstract：
Objective: The purpose of this study was to report a case of herpes simplex virus-1 (HSV-1) keratitis misdiagnosed as fungal keratitis due to its clinical presentation being similar to that of fungal keratitis, ultimately diagnosed by NGS. Patients and Methods: A 59-year-old male presented with reduced vision in the right eye, combined with a history of trauma with vegetative matter. The corneal ulcer was accompanied with feathery infiltration, satellite lesion, and endothelial plaques. In vivo confocal microscopy (IVCM) showed hyper-reflective linear, thin, and branching interlocking structures. Fungal keratitis was diagnosed. Voriconazole 100 mg orally daily, topical tobramycin and 1% voriconazole were initiated empirically right away. The condition was aggravated and penetrating keratoplasty was performed. Anterior segment optical coherence tomography (AS-OCT) demonstrated the presence of plaques with a clear boundary between plaques and endothelium, resembling the AS-OCT images observed in cases of viral keratitis. Next-generation sequencing (NGS) further detected HSV-1 deoxyribonucleic acid, and no fungal component was found. Antifungal agents were discontinued and antiviral treatments were added. Results: We successfully treated a patient with HSV-1 keratitis who was misdiagnosed due to clinical features and IVCM findings similar to fungal keratitis. The patient\'s infection was controlled. At 2 years after surgery, the cornea recovered well. Conclusions: HSV-1 keratitis with atypical clinical presentation can be easily misdiagnosed. This case report emphasizes the importance of NGS in diagnosing the pathogens of keratitis.
摘要：
目的：本研究的目的是报告1例单纯疱疹病毒1型（HSV-1）角膜炎，由于其临床表现与真菌性角膜炎相似，误诊为真菌性角膜炎。最终由NGS诊断。患者和方法：一名59岁男性，右眼视力下降，再加上植物人的外伤史.角膜溃疡伴羽状浸润，卫星病变,和内皮斑块。体内共聚焦显微镜（IVCM）显示出超反射线性，薄,和分支互锁结构。诊断真菌性角膜炎。伏立康唑每天口服100毫克，局部用妥布霉素和1%伏立康唑是经验性的开始.病情加重，行穿透性角膜移植术。前段光学相干断层扫描（AS-OCT）显示斑块的存在，斑块和内皮之间有清晰的边界，类似于在病毒性角膜炎病例中观察到的AS-OCT图像。下一代测序（NGS）进一步检测到HSV-1脱氧核糖核酸，没有发现真菌成分。停用抗真菌剂并添加抗病毒治疗。结果：我们成功治疗了一名HSV-1角膜炎患者，该患者因临床特征和IVCM表现与真菌性角膜炎相似而被误诊。患者的感染得到控制。手术后2年,角膜恢复良好。结论:HSV-1型角膜炎临床表现不典型,易误诊。该病例报告强调了NGS在诊断角膜炎病原体中的重要性。
