Diabetic Peripheral Neuropathy Triggers Herpes Simplex Keratitis Recurrence: A Novel Molecular Mechanism Study and Hypothesis

Diabetes Mellitus (DM) most commonly affects the retina, irides and crystalline lens. However, never is known about the Diabetic Peripheral Neuropathy (DPN) triggered Herpes Simplex Keratitis (HSK). The interaction between HSK and DPN was also investigated to attempt to provide an assistant for clinical diagnosis. A 62-year-old Chinese man, with a history of diabetes for many years, was recruited in this study. Laboratory Examinations were employed to diagnose DM. Routine examination, slit-lamp examination, cornea confocal microscope and indirect Immunofluorescence assay (IFA) were employed to examine Ophthalmological disease. Electromyogram (EMG) and Michigan Neuropathy Screening Instrument (MNSI) were utilized to diagnose DPN. By ophthalmological examination and IFA assay, patient was diagnosed as epithelial HSK. However, anti-viral treatment could not significantly improve corneal symptoms. Meanwhile, by laboratory examinations and neurological analysis, this patient was diagnosed as DPN combined with epithelial HSK finally. By treating with anti-viral drugs and anti-DPN drugs, the symptoms of cornea were significantly improved. In conclusion, we reported and investigated the DPN combined with epithelial HSK for the first time. DPN might trigger HSK in patient with history of diabetes mellitus. Anti-viral drugs together with anti-DPN drugs would be a promising program for this kind of patient.