Bilateral Herpes Simplex Keratitis With Unilateral Secondary Bacterial Keratitis and Corneal Perforation in a Patient With Pityriasis Rubra Pilaris

Purpose: To report a case of bilateral herpes simplex keratitis with unilateral secondary bacterial keratitis resulting in corneal perforation in a patient with pityriasis rubra pilaris. Methods: Case report. Results: A 77-year-old female with pityriasis rubra pilaris was referred for a perforated comeal ulcer of the left eye. Cultures were positive in both eyes for Herpes simplex and in the left eye for Pseudomonas fluorescens and Staphylococcus aureus A microbiological cure was obtained with a combination of tectonic keratoplasty, fortified topical antibiotics, and systemic acyclovir. Conclusions: Pityriasis rubra pilaris is a rare, inflammatory dermatologic disease that may predispose patients to bilateral Herpes simplex keratitis, secondary bacteria] superinfection, and a tendency toward rapid stromal ulceration with risk of perforation.