A 36-year-old man with a history of previously treated latent tuberculosis and syphilis presented with right eye pain, redness, blurry vision, photosensitivity, and watery discharge for one month.
Review of his medical records revealed that he was previously evaluated for a facial rash one week prior. Swab of a facial lesion was PCR positive for Opox. His facial lesions resolved over seven days.
Ophthalmic examination was significant for mild right eyelid edema and mild right eye conjunctivitis (Fig. 2B). The right eye had stromal interstitial keratitis and an inferior corneal ulcer. He was treated with topical moxifloxacin and fortified vancomycin and tobramycin, and oral valacyclovir without improvement. A corneal swab obtained on admission resulted PCR-positive for Opox. He was treated with oral tecovirimat and topical ocular trifluridine, tobramycin, and prednisolone. HIV therapy was initiated with bictegravir-emtricitabine-tenofovir. He completed a 30-day course of oral tecovirimat, and he continues on topical ocular trifluridine and erythromycin. Photophobia, tearing and eye pain resolved after six weeks of treatment; however, his vision did not improve. Following four weeks of treatment, corneal swab for Opox PCR test was negative.