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January 2015

Conjunctival Pseudotumor Caused by Herpes Simplex Virus Infection

Author Affiliations
  • 1Department of Cornea and Refractive Surgery, Duke Eye Center, Durham, North Carolina
  • 2Department of Ophthalmic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
  • 3Department of Pathology, Duke Eye Center, Durham, North Carolina
  • 4Department of Vitreoretinal Surgery and Ocular Oncology, Duke Eye Center, Durham, North Carolina
JAMA Ophthalmol. 2015;133(1):105-107. doi:10.1001/jamaophthalmol.2014.3316

A conjunctival mass in a patient with human immunodeficiency virus (HIV) can have a long differential diagnosis, ranging from opportunistic infections to malignant neoplasms. Given that patients in this population may have atypical presentations, the benefit of invasive biopsy often outweighs surgical risk and can help guide treatment. We report 2 cases of patients referred to our ocular oncology services with herpetic conjunctivitis that masqueraded as conjunctival tumors.

A man in his early 50s with a history of herpes simplex virus (HSV) keratouveitis presented with increasing left eye pain for 2 months. His medical history was significant for HIV (CD4 lymphocyte count, 525/μL [to convert to ×109 per liter, multiply by 0.001]; viral load undetectable) and hepatitis C. On examination, a fleshy yellow conjunctival lesion with subconjunctival hemorrhage was noted (Figure 1A), with a follicular reaction on the tarsal conjunctiva. Given the patient’s complex medical history and presentation, an incisional biopsy was performed. Intraoperatively, the lesion was noted to be gelatinous, with a keratinized superficial layer firmly adherent to the conjunctiva.

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