VACCINIA KERATOUVEITIS MANIFESTING AS A MASQUERADE SYNDROME

A patient who used contact lenses and had a history of blunt trauma de veloped vaccinia keratouveitis after accidental ocular autoinoculation from a recent vaccination site. Corneal and conjunctival cultures wer e taken for bacteria, fungi, Acanthamoeba, and viruses. Viral-like cyt opathic effects became evident in tissue culture within three days. Im munofluorescence studies were negative for varicella-zoster virus, her pes simplex virus, adenovirus, measles, mumps, parainfluenza, and infl uenza. Fox viral particles were identified in the infected tissue cult ures by electron microscopy. The Hind III restriction endonuclease pro file of the viral DNA isolate was similar to the Lister strain of vacc inia virus. Ocular vaccinia may manifest as a masquerade syndrome and may mimic signs of herpes simplex virus, varicella-zoster virus, and A canthamoeba infection. Although vaccination with vaccinia is currently limited to a few populations throughout the world, vaccinia must stil l be considered in the differential diagnosis of infectious keratouvei tis.