Case Study: January 2014


  • 55 year old man with a history of chronic keratitis.
  • Develops a corneal ulcer and then perforates the cornea over a matter of a few days.
  • Evisceration performed.
  • Sections show cornea sections only (Fig 1 and 2).


  1. Which distinctive features are seen on Fig 2?
  2. What is the likeliest diagnosis?
  3. Which further tests can be performed on this tissue to confirm the diagnosis?
Click to show answers
  1. The corneal epithelium shows cells with intranuclear, grey viral inclusions.
  2. The H&E diagnosis is that of herpes simplex keratitis.
  3. HSV immunohistochemistry-see fig 3. it was positive in the same area as the epithelial nuclear inclusions. Can also do PCR on paraffin sections and if required, transmission electron microscopy.