Atypical viral keratitis in a graft

A 70-year-old male patient, a known case of rheumatoid arthritis, presented with multiple elevated atypical vesicular corneal lesions admixed with an active epithelial defect in the right eye for 2 days. The patient was operated penetrating keratoplasty for mixed keratitis 2 months back. Based on history and clinical findings, a working diagnosis of viral keratitis was made, and the treatment regimen was changed to topical and systemic anti-viral therapy. Subsequently at the end of 2 weeks, the vesicular lesions transformed themselves into umbilicated lesion and healed thereof. Viral keratitis can have a myriad of atypical presentations; therefore, under such circumstances, a strong clinical suspicion with pre-emptive systemic examination will be helpful in achieving optimal outcomes.