Recurrent herpes zoster ophthalmicus in a young, healthy individual taking high doses of l-Arginine.
Level 4 - case-series / case-control
Single clinical case report
PubMed 31497676 · doi:10.1016/j.ajoc.2019.100547
What was done
A case report detailing a 39-year-old immunocompetent male weightlifter who presented with recurrent herpes zoster ophthalmicus (HZO) in the right eye. A dietary recall was conducted to assess supplemental amino acid intake prior to both HZO episodes.
What was found
The patient experienced an HZO recurrence four months after successful treatment of the initial episode with oral acyclovir. Diet recall indicated an average daily supplemental L-arginine intake of 46.5 g prior to both episodes. Examination showed 20/40 best-corrected visual acuity, anterior stromal haze in the visual axis, and inferior superficial punctate keratitis in the affected eye. Management consisted of continuing prophylactic oral acyclovir (1 g daily), punctal plugs and artificial tears for dry eye disease, and discontinuation of high-dose L-arginine supplements.
Why it matters
In vitro evidence demonstrates that L-arginine promotes herpesvirus replication, and this report raises the possibility that massive L-arginine supplementation might trigger varicella zoster reactivation in young, healthy hosts.
Limits
This is an uncontrolled single-patient report (n=1), which cannot establish causality. Dietary intake was estimated retrospectively via self-report recall. The patient was maintained on acyclovir prophylaxis alongside supplement cessation, confounding any assessment of supplement discontinuation alone.
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