Bilateral herpes simplex keratitis: A rare complication in a patient with pemphigus foliaceus

Bilateral Herpes simplex keratitis (HSK) is relatively rare and often occurs in individual with compromised immune system, measles and long term use of corticosteroid for any autoimmune disease. We report a rare case of bilateral HSK in a 62-year old female patient with pemphigus foliaceus (PF) on injectable steroid for acute exacerbation. The patient presented with pricking sensation, blurring of vision in both eyes and characteristic skin lesions. The patient was treated with topical and systemic antiviral medication. The systemic steroid were tapered and stopped. Patient received injection Rituximab. In 3 weeks patient improved significantly. Topical and systemic antiviral were tapered and stopped over next 3 weeks as no active lesion was noted. Patient underwent uneventful cataract surgery in both eyes after 4 months. This case highlights the co-existence of these two conditions and multidisciplinary approach to prevent complication and improve outcome.