Recurrent herpes simplex virus nummular keratitis in a case of irritable bowel syndrome and seronegative ankylosing spondylitis

A 35-year-old male presented with a 16-month history of left-eye recurrent redness, photophobia, and blurring in his left eye. Systemically, he suffered from irritable bowel syndrome and HLA-B27-negative spondyloarthropathy. The cornea showed multiple nummular epithelial and anterior stromal lesions. The aqueous sample was positive for herpes simplex virus-1 DNA (glycoprotein-D gene) by polymerase chain reaction. The lesions resolved with oral acyclovir and topical dexamethasone 0.01% in tapering doses; however, he continued to have recurrent periodic redness even at 1 year. We hypothesize that coexisting systemic immune-mediated conditions may have a role in altering the disease course leading to its prolongation in our case.