Virology USMLE Step 1 Practice Question
A 45-year-old man with a history of recurrent cold sores presents with severe blepharitis, conjunctivitis, and corneal dendritic ulcers confirmed by fluorescein staining. He has been applying topical corticosteroids to his eye for 3 weeks without improvement. His lesions are now worsening with deeper stromal involvement. Which of the following best explains the paradoxical worsening of his condition?
Answer choices
- ACorticosteroids cross the blood-brain barrier and inhibit trigeminal ganglia immune responses
- BTopical corticosteroids suppress local immune responses, allowing deeper viral invasion and stromal inflammationCorrect answer
- CCorticosteroids promote epithelialization, which traps virus beneath healing epithelium
- DProlonged corticosteroid use causes secondary bacterial superinfection of viral lesions
- EThe corticosteroid vehicle increases corneal osmolarity, causing epithelial cell death
- FCorticosteroids inhibit interferon-gamma production, which is essential for preventing herpes simplex virus reactivation from the corneal nerve plexus
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