Ten days after recovering from a painful epidemic keratoconjunctivitis, a 35-year-old notices blurred vision with multiple small round white opacities just beneath the corneal epithelium that stain faintly with fluorescein. The responsible virus and the characteristic lesion are:

• A Adenovirus type 8 or 19, subepithelial nummular infiltrates ✓
• B Herpes simplex virus, dendritic ulcer
• C Enterovirus 70, punctate epithelial erosions
• D Coxsackievirus A24, ring-shaped stromal scar

Explanation

Epidemic keratoconjunctivitis is caused by adenovirus serotypes 8 and 19 (type 37 also reported). After the acute phase resolves, immune-mediated subepithelial nummular infiltrates appear under the healing epithelium and may persist for months, reducing vision. Herpes simplex gives a branching dendritic ulcer, not diffuse nummular opacities. Enterovirus 70 and coxsackievirus B24 cause acute haemorrhagic conjunctivitis without these delayed infiltrates.

Reference: Parsons' Diseases of the Eye, 23rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.