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Sanjay S, Sharief S, Joshi A, Yadav NK. Long-term follow-up of acute retinal necrosis with retinal detachment secondary to herpes simplex virus type 2 with a successful visual outcome. BMJ Case Rep 2023; 16:e252913. [PMID: 37185312 PMCID: PMC10151916 DOI: 10.1136/bcr-2022-252913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
A man in his early 20s presented with acute loss of vision in his only eye, the left eye (OS), and was on oral steroids. He had lost vision in his right eye during his childhood and the cause was unknown. There was no history of trauma. Best-corrected visual acuity (BCVA) in OS was 20/100 and in the right eye was hand movements. OS showed non-granulomatous keratic precipitates on the cornea, anterior chamber flare 1+ and cell 1+, early cataract, vitreous haze and cells 2+ with nasal retinal detachment and superior full thickness retinitis. He underwent pars plana vitrectomy with intravitreal ganciclovir and barrage laser away from the necrotic retina. PCR for herpes simplex virus 2 was positive from the aqueous and vitreous sample. He was started on oral valacyclovir 1 g three times a day and continued on tapering dose of oral steroids. BCVA in OS at 6-month follow-up was 20/25.
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Affiliation(s)
- Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
| | - Shama Sharief
- Vitreo-retina, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aishwarya Joshi
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
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Kinoshita T, Hatanaka A, Mori J, Akaiwa K, Imaizumi H. Multimodal Imaging of a Severe Case of Neonatal Acute Retinal Necrosis and Lens Vacuoles Associated with Herpes Simplex Virus Infection. Ocul Immunol Inflamm 2021; 30:1009-1015. [PMID: 33539717 DOI: 10.1080/09273948.2020.1841803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To report a case of a neonate with acute retinal necrosis, lens vacuoles, and encephalitis associated with herpes simplex virus (HSV) infection. DESIGN Case report. METHODS Retrospective chart review. RESULTS A male neonate was brought for screening for retinopathy of prematurity at the corrected age of 32 weeks. Slit-lamp examination showed lens vacuoles in both eyes. Fundus examination revealed extensive retinal detachments with prominent retinal whitening, subretinal exudates, and retinal hemorrhage. Computed tomography of the brain showed encephalomalacia. Polymerase chain reaction of cerebrospinal fluid and anterior chamber fluid was both positive for HSV-1. Despite systemic anti-viral therapy, a rhegmatogenous retinal detachment and subsequent proliferative vitreoretinopathy developed in the patient's right eye. The retinal detachment in the left eye resolved, but significant chorioretinal degeneration occurred. With time lens vacuoles decreased in number. CONCLUSIONS Clinicians should remember this rare, but devastating condition without specific prodromal symptoms.
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Affiliation(s)
- Takamasa Kinoshita
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Akira Hatanaka
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Junya Mori
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Kei Akaiwa
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
| | - Hiroko Imaizumi
- Department of Ophthalmology, Sapporo City General Hospital, Sapporo, Japan
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3
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Khurram D, Ali SM, Kozak I. Bilateral acute retinal necrosis in premature newborn with skin, eye, and mouth infection presenting with vitreous and subretinal hemorrhage. Indian J Ophthalmol 2020; 68:2009-2011. [PMID: 32823461 PMCID: PMC7690509 DOI: 10.4103/ijo.ijo_1038_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A premature newborn with systemic sepsis due to Candida albicans and parapsilosis developed skin, eye, and mouth herpetic infection. Ocular disease presented atypically with vitritis and pre and subretinal hemorrhage due to herpes simplex virus-1 confirmed fulminant bilateral acute retinal necrosis. Pars plana vitrectomy revealed necrotizing retinitis with poor visual prognosis. The baby has survived suffering from multiple morbidities which include post-hemorrhagic hydrocephalus, chronic lung disease, patent ductus arteriosus, and developmental delay.
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Affiliation(s)
| | - Syed M Ali
- Moorfield Eye Hospitals UAE, Dubai, U.A.E
| | - Igor Kozak
- Moorfield Eye Hospitals UAE, Dubai, U.A.E
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Mahendradas P, Sinha S, Vinekar A, Pradeep M, Shetty BK. Bilateral acute necrotizing retinitis due to cytomegalovirus infection in an infant: Challenging case report. Am J Ophthalmol Case Rep 2019; 16:100553. [PMID: 31650082 PMCID: PMC6804511 DOI: 10.1016/j.ajoc.2019.100553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose To report a case of bilateral acute necrotising retinitis due to cytomegalovirus infection (CMV) in an Asian Indian infant. Observations An Asian Indian infant born with a birth weight of 1000 g at 26 week of gestation acquired cytomegalovirus infection from repeated blood transfusion for anemia. During the routine course of ROP screening, both eyes were detected with Type 1 ROP (stage 3 in zone 1 with plus disease) and treated with laser photoablation at 39 + 2 weeks post menstrual age. The disease responded to the laser and showed signs of regression. Four weeks after laser therapy (PMA 43 + 3 weeks), both eyes presented with vitritis, inferior vitreous condensation and white lesions in the lower nasal retina and temporal retina overlying the lasered retinal bed associated with white fluffy hemorrhagic lesions resembling necrotising retinitis. As the infant was seropositive for CMV earlier, Necrotising retinitis due to CMV was suspected. The CMV DNA was repeated and was detected in serum. Infant was treated with anti-CMV medication (oral valgancyclovir) for six weeks. The retinal lesions resolved completely. Conclusion and Importance Bilateral acute necrotising retinitis may present in an infant on post lasered retina as early as 16 weeks after birth. CMV may also present as acute necrotising retinitis in unusual cases therefore high index of suspicion and early management can result in a successful outcome.
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Wang D, Bloomberg JD, Sobrin L, Goldstein D, Skondra D. Atypical herpes simplex virus type 2 acute retinal necrosis presentation with large subretinal lesion. Am J Ophthalmol Case Rep 2019; 15:100501. [PMID: 31304428 PMCID: PMC6599871 DOI: 10.1016/j.ajoc.2019.100501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 11/06/2022] Open
Abstract
Purpose To report the unique clinical findings of a case of Herpes Simplex Virus Type 2 herpetic retinitis manifesting as a large elevated subretinal lesion. Observations A 26-year-old Hispanic male with no significant past medical history presented with a one-week history of right eye pain and endorsement of worsening vision. Ophthalmic examination of the right eye identified a markedly elevated white subretinal lesion with associated findings of vitritis and hypotony. Ultrasound biomicroscopy demonstrated a diffusely thickened choroid and confirmed the observed subretinal mass. Examination of the fellow left eye was largely unremarkable with the exception of lesions suggestive of inactive chorioretinal scars. Diagnostic vitrectomy and vitreous PCR (polymerase chain reaction) was positive only for HSV-2 (herpes simplex virus type 2) and verified by two independent laboratories. The observed subretinal lesion of right eye improved on intravenous acyclovir and intravitreal foscarnet treatment. Conclusions and Importance Presented here is an unusual, novel clinical presentation of HSV-2 acute retinal necrosis manifesting as an elevated subretinal lesion along with findings of panuveitis. This case suggests that consideration should be given to the diagnosis of HSV ARN (acute retinal necrosis) when a subretinal elevation is concomitantly appreciated in the setting of vitritis and chorioretinal lesions.
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Affiliation(s)
- Daniel Wang
- Department of Ophthalmology, New York Eye and Ear Infirmary, 310 E. 14th Street, New York, NY, USA
| | - Justin D Bloomberg
- Department of Ophthalmology, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Avenue, Chicago, IL, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, USA
| | - Debra Goldstein
- Department of Ophthalmology, Northwestern University, 645 N. Michigan Avenue, Chicago, IL, USA
| | - Dimitra Skondra
- Department of Ophthalmology, The University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, USA
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6
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Acute retinal necrosis in a neonate with HSV II encephalitis. Pediatr Neonatol 2019; 60:344-345. [PMID: 30122364 DOI: 10.1016/j.pedneo.2018.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 03/31/2018] [Accepted: 06/08/2018] [Indexed: 11/23/2022] Open
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Kobayashi T, Sekar P, Meier J, Streit J. Acute retinal necrosis in a patient with remote severe herpes simplex encephalitis. BMJ Case Rep 2019; 12:12/5/e229137. [PMID: 31138593 DOI: 10.1136/bcr-2018-229137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 60-year-old man with a history of severe herpes simplex virus type 1 (HSV-1) encephalitis 2 years prior presented with acute onset of visual loss in the left eye. Dilated funduscopic examination showed retinitis and occlusive vasculitis with retinal necrosis. PCR of the vitreous fluid was positive for HSV-1, and he was diagnosed with acute retinal necrosis (ARN) due to HSV-1. The patient was treated with intravenous acyclovir and intravitreous foscarnet for 2 weeks, followed by high dose oral valacyclovir for 2 weeks. He was subsequently placed on planned life-long suppressive valacyclovir. His case demonstrates that acute visual loss concomitant with or subsequent to HSV-1 encephalitis warrants suspicion of ARN. Prompt therapy with effective antiviral medication is necessary to reduce the risk of sight-threatening complications. Chronic suppression with oral antiviral therapy after ARN is recommended to prevent involvement of the contralateral eye, though there is no consensus on the duration and dosage of antivirals.
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Affiliation(s)
- Takaaki Kobayashi
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Poorani Sekar
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jeffery Meier
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Judy Streit
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Bae MH, Lee NR, Han YM, Yoon L, Kim YM, Byun SY, Lee JJ, Kwon HJ, Kwak MJ, Park KH. Bilateral Acute Retinal Necrosis and Encephalomalacia Due to Herpes Simplex Virus Infection in a Premature Infant. NEONATAL MEDICINE 2019. [DOI: 10.5385/nm.2019.26.1.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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Miserocchi E, Iuliano L, Fogliato G, Modorati G, Couto C, Schlaen A, Hurtado E, Llorenç V, Adan A, Bandello F. Bilateral Acute Retinal Necrosis: Clinical Features and Outcomes in a Multicenter Study. Ocul Immunol Inflamm 2018; 27:1090-1098. [PMID: 30059636 DOI: 10.1080/09273948.2018.1501494] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To describe clinical features and outcome in bilateral acute retinal necrosis (BARN). Methods: Observational retrospective longitudinal review of ocular findings. Results: Thirty eyes of 15 patients (age 44.1 ± 15.8). Delay of involvement between eyes was 57.2 ± 105.2 months (median 3, range 0.5-360). Herpes simplex virus (HSV)-1 was the most frequent (20 eyes, 66.6%), followed by HSV-2 (five eyes, 16.7%) and varicella zoster virus (VZV, four eyes, 13.3%). Visual acuity worsened in 7 (23%) eyes, improved in 4 (13%), and remained stable in 19 (63%). Major complications included retinal detachment (11 eyes, 36%), optic atrophy (11 eyes, 33%), proliferative vitreoretinopathy (four eyes, 13.3%), neovascular glaucoma (four eyes, 13.3%), phthisis bulbi (three eyes, 10%). Symptoms-to-referral average time was 2.7 ± 1.0 weeks (range 1-4). Conclusions: In our study BARN was associated with severe visual outcome and high rate of ocular complications. Although BARN is a rare disease, the course is aggressive, regardless prompt referral in tertiary-care uveitis centers.
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Affiliation(s)
- Elisabetta Miserocchi
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Lorenzo Iuliano
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Giulio Modorati
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
| | - Cristobal Couto
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Ariel Schlaen
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Erika Hurtado
- Ophthalmology Service, Hospital de Clinicas "José de San Martín", Universidad de Buenos Aires , Buenos Aires , Argentina
| | - Victor Llorenç
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Alfredo Adan
- Clínic Institute of Ophthalmology, Clínic Hospital, Universitat de Barcelona , Barcelona , Spain
| | - Francesco Bandello
- Department of Ophthalmology, Ospedale San Raffaele Scientific Institute, University Vita-Salute , Milan , Italy
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10
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Weissman HM, Biousse V, Schechter MC, Del Rio C, Yeh S. Bilateral central retinal artery occlusion associated with herpes simplex virus-associated acute retinal necrosis and meningitis: case report and literature review. Ophthalmic Surg Lasers Imaging Retina 2015; 46:279-83. [PMID: 25707059 DOI: 10.3928/23258160-20150213-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 10/01/2014] [Indexed: 11/20/2022]
Abstract
A 60-year-old woman with a history of recurrent headaches and blurred vision presented with bilateral optic disc edema. Optic neuritis was suspected, and intravenous methylprednisonlone was administered. Her vision declined to hand motions in both eyes, and subsequent evaluation revealed bilateral acute retinal necrosis with bilateral central retinal artery occlusions (CRAO). Aqueous humor polymerase chain reaction analysis was positive for herpes simplex virus (HSV), establishing a diagnosis of HSV-associated bilateral acute retinal necrosis (ARN) and meningitis. CRAO has rarely been reported in association with ARN, and a fulminant course with bilateral CRAO in association with ARN has not been previously reported. This case emphasizes the importance of careful peripheral examination in patients with presumptive optic neuritis, judicious use of systemic corticosteroid in this context, and the retinal vaso-obliterative findings that may be observed in the pathogenesis of ARN.
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MESH Headings
- Antibodies, Viral/blood
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- DNA, Viral/genetics
- Drug Therapy, Combination
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Female
- Fluorescein Angiography
- Foscarnet/therapeutic use
- Ganciclovir/therapeutic use
- Herpes Simplex/diagnosis
- Herpes Simplex/drug therapy
- Herpes Simplex/virology
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/immunology
- Herpesvirus 2, Human/isolation & purification
- Humans
- Magnetic Resonance Imaging
- Meningitis, Viral/diagnosis
- Meningitis, Viral/drug therapy
- Meningitis, Viral/virology
- Middle Aged
- Polymerase Chain Reaction
- Retinal Artery Occlusion/diagnosis
- Retinal Artery Occlusion/drug therapy
- Retinal Artery Occlusion/virology
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/drug therapy
- Retinal Necrosis Syndrome, Acute/virology
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11
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Venincasa VD, Emanuelli A, Leng T, Perlini E, Villegas V, Diaz-Barbosa M, Gutierrez M, Miller D, Berrocal AM. Acute Retinal Necrosis Secondary to Herpes Simplex Virus Type 2 in Neonates. Ophthalmic Surg Lasers Imaging Retina 2015; 46:499-501. [DOI: 10.3928/23258160-20150422-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/13/2014] [Indexed: 11/20/2022]
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LaMattina KC, Wirostko WJ, Costakos DM. Bilateral Acute Retinal Necrosis with Concurrent Retinopathy of Prematurity in Two Neonates. Ocul Immunol Inflamm 2014; 24:115-7. [DOI: 10.3109/09273948.2014.916724] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Kara C. LaMattina
- John H. Stroger Hospital of Cook County, Division of Ophthalmology, Chicago, Illinois, USA and
| | - William J. Wirostko
- The Eye Institute of the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Deborah M. Costakos
- The Eye Institute of the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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13
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Abstract
We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.
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14
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McGrath L, Woods M, Lee L, Conrad D. Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review. Digit J Ophthalmol 2013; 19:28-32. [PMID: 24109247 DOI: 10.5693/djo.02.2013.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
HSV-2 is an important cause of the acute retinal necrosis (ARN) syndrome in younger patients. We describe an atypical case of HSV-2 ARN in the context of neonatal exposure and subconjunctival steroid injection. Clinicians should be aware of the association of neonatal or congenital exposure to HSV-2 as a risk factor for this disease because early treatment may improve outcome and/or avoid involvement of both eyes.
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Affiliation(s)
- Lindsay McGrath
- Department of Ophthalmology, Royal Brisbane & Women's Hospital; ; School of Medicine, University of Queensland, Brisbane
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15
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Gupta A, Rani PK, Bagga B, Dore P, Mittal A, Jalali S. Bilateral herpes simplex-2 acute retinal necrosis with encephalitis in premature twins. J AAPOS 2010; 14:541-3. [PMID: 21168079 DOI: 10.1016/j.jaapos.2010.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 08/13/2010] [Accepted: 08/17/2010] [Indexed: 10/18/2022]
Abstract
Acute retinal necrosis, caused by the herpes family of viruses, is a rapidly progressing ocular inflammatory disorder commonly reported in adults but rarely in children. The accepted diagnostic criteria include presence of 1 or more foci of retinal necrosis, rapid progression, circumferential spread, occlusive vasculopathy, and inflammation in the vitreous and anterior chamber. We report bilateral acute retinal necrosis with encephalitis due to herpes simplex virus (HSV-2) in newborn twins.
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Affiliation(s)
- Amit Gupta
- Srimati Kannuri Santhamma Centre for Vitreo Retinal Diseases, Hyderabad, India
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16
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Rautenberg P, Grancicova L, Hillenkamp J, Nölle B, Roider JB, Fickenscher H. [Acute retinal necrosis from the virologist's perspective]. Ophthalmologe 2010; 106:1065-73. [PMID: 19838711 DOI: 10.1007/s00347-009-2048-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute retinal necrosis occurs in approximately one per million persons per year and is caused in approximately 70% of the cases by the varicella zoster virus or in about 30% of the cases by herpes simplex virus. The early diagnosis is primarily based on virus-specific polymerase chain reaction in fluid from the anterior chamber or vitreous humor and can be supported by the determination of specific antibody titers from fluid and serum. Virus detection provides the basis for early causative therapy which limits disease progression and risk of complications. Retinal infections by varicella zoster virus or herpes simplex virus are treated with aciclovir, ganciclovir, or famciclovir. Ganciclovir and valganciclovir are used for the therapy of retinal cytomegalovirus infections. In the case of resistance development, foscarnet or cidofovir are available as second line antiviral drugs. The early use of specific antiviral agents is a crucial prerequisite for optimized therapy of acute retinal necrosis.
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Affiliation(s)
- P Rautenberg
- Institut für Infektionsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 32, 24105, Kiel, Deutschland.
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17
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Wong RK, Khanifar AA, Sun G, Heier LA, Saffra N, Chan RVP. Acute retinal necrosis and cystic encephalomalacia in a premature neonate. Retin Cases Brief Rep 2010; 4:202-205. [PMID: 25390403 DOI: 10.1097/icb.0b013e3181ad3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report a case of an infant born at 30 weeks gestational age (GA) who, at 37 weeks GA, presented with bilateral acute retinal necrosis (ARN) syndrome and herpes simplex virus (HSV) encephalomalacia. METHODS Observational case report. RESULTS A premature infant was found to have ARN based on dilated funduscopic examination and positive HSV serologies. Herpes simplex virus encephalomalacia was diagnosed base on magnetic resonance imaging (MRI). CONCLUSION To our knowledge, this is the youngest reported patient with ARN. This case demonstrates that neonatal ARN may present with posterior chorioretinal lesions and highlights the importance of considering HSV infection of the central nervous system with MRI findings of cystic encephalomalacia.
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Affiliation(s)
- Ryan K Wong
- From the Departments of *Ophthalmology and †Radiology, Weill Cornell Medical College, New York, New York; and ‡Division of Ophthalmology, Maimonides Medical Center, Brooklyn, New York
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18
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King J, Chung M, DiLoreto DA. A 9 Year-Old Girl with Herpes Simplex Virus Type 2 Acute Retinal Necrosis Treated with Intravitreal Foscarnet. Ocul Immunol Inflamm 2009; 15:395-8. [DOI: 10.1080/09273940701486431] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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HSV2 acute retinal necrosis: diagnosis and monitoring with quantitative polymerase chain reaction. Int Ophthalmol 2008; 29:199-201. [PMID: 18297242 DOI: 10.1007/s10792-008-9198-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe a case of HSV2 acute retinal necrosis (ARN) diagnosed and monitored with quantitative polymerase chain reaction (PCR) in ocular fluids. DESIGN Case report. METHODS Quantitative PCR was performed in the aqueous humor (AH) and vitreous using primers specific for herpes virus. RESULTS A positive PCR was found for HSV2 in the AH (>100,000,000 viral copies - 8.00 log/ml). After therapy, another anterior chamber tap showed a reduction of the viral load at 4.28 log/ml (19205 copies), confirming the efficacy of the treatment. After six months, PCR on the vitreous still showed the presence of HSV2 viral particles in the eye (3.14 log DNA copies/ml, 1379 copies) although the lesion was healed. CONCLUSIONS This case demonstrates that PCR is useful to detect viral DNA in AH and vitreous and to monitor viral activity and therapeutic response. Viral DNA persists in ocular fluids for months in the presence of a healed infection.
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20
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Landry ML, Mullangi P, Nee P, Klein BR. Herpes simplex virus type 2 acute retinal necrosis 9 years after neonatal herpes. J Pediatr 2005; 146:836-8. [PMID: 15973328 DOI: 10.1016/j.jpeds.2005.02.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many cases of acute retinal necrosis caused by HSV-2 have been reported in children, teenagers, and young adults as a result of reactivation of congenital or neonatal infections, which may have been subclinical. Pediatricians should be aware of this entity and alert to recurrences that may be delayed by years.
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Affiliation(s)
- Marie L Landry
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Conneticut 06520-8035, USA.
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Affiliation(s)
- Ehud Zamir
- Ocular Immunology Service, The Royal Victorian Eye and Ear Hospital, 32 Gisborne Street, East Melbourne, Victoria 3002, Australia
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22
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Tran THC, Rozenberg F, Fillet AM, Bodaghi B. Diagnostic and therapeutic management of a severe acyclovir-resistant acute retinal necrosis in a young child. Graefes Arch Clin Exp Ophthalmol 2004; 243:266-8. [PMID: 15378385 DOI: 10.1007/s00417-004-0985-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Revised: 06/12/2004] [Accepted: 06/21/2004] [Indexed: 11/27/2022] Open
Affiliation(s)
- T H C Tran
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
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Tran THC, Stanescu D, Caspers-Velu L, Rozenberg F, Liesnard C, Gaudric A, Lehoang P, Bodaghi B. Clinical characteristics of acute HSV-2 retinal necrosis. Am J Ophthalmol 2004; 137:872-9. [PMID: 15126152 DOI: 10.1016/j.ajo.2003.12.036] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2003] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the clinical features and evaluate the visual outcome of eleven cases of herpes simplex virus-2 (HSV-2) related acute retinal necrosis syndrome (ARN). DESIGN Retrospective interventional case series. METHODS Twelve eyes of eleven patients from two European centers, diagnosed with HSV-2 related acute retinal necrosis syndrome were retrospectively reviewed. Herpes simplex virus-2 DNA was detected by polymerase chain reaction in intraocular fluids (aqueous and/or vitreous). Findings at initial examination, clinical evolution with antiviral therapy, complications and final visual acuity were evaluated. RESULTS Herpes simplex virus-2 DNA was detected in all cases. No sample was positive for more than one virus. The mean age of disease in the first eye was 36 years (ranged from 10 to 57 years). Five patients were women and six were men. All patients were immunocompetent. Previous medical history included neonatal herpes (n = 1), previous ARN (n = 3), trauma (n = 1) and systemic corticosteroid administration before occurrence of ARN (n = 3). Preexisting pigmented chorioretinal scars were found in three cases. Patients were treated with high dose intravenous acyclovir or foscarnet +/- intravitreal ganciclovir +/- interferon. The mean follow-up was 14.5 months (from 5 to 22 months). At the end of the follow-up period, five eyes (41.7%) showed improvement of visual acuity of two or more lines. Final visual acuity was 20/60 or better in four eyes (33.3%), 20/400 or better in four eyes (33.3%) and less than 20/400 in four eyes. CONCLUSION History of neonatal herpes, triggering events such as neurosurgery, periocular trauma, high-dose corticosteroids, and chorioretinal scars suggest that HSV-2 retinitis reflects reactivation of HSV-2 infection.
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MESH Headings
- Acyclovir/therapeutic use
- Adult
- Antiviral Agents/therapeutic use
- Aqueous Humor/virology
- Child
- DNA, Viral/analysis
- Drug Therapy, Combination
- Eye Infections, Viral/diagnosis
- Eye Infections, Viral/drug therapy
- Eye Infections, Viral/virology
- Female
- Foscarnet/therapeutic use
- Ganciclovir/therapeutic use
- Herpes Simplex/diagnosis
- Herpes Simplex/drug therapy
- Herpes Simplex/virology
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Humans
- Interferons/therapeutic use
- Male
- Middle Aged
- Polymerase Chain Reaction
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/drug therapy
- Retinal Necrosis Syndrome, Acute/virology
- Retrospective Studies
- Virus Activation
- Visual Acuity
- Vitreous Body/virology
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Affiliation(s)
- Thi Ha Chau Tran
- Department of Ophthalmology, Pitié-Salpetrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Tran THC, Bodaghi B, Rozenberg F, Cassoux N, Fardeau C, LeHoang P. Prise en charge diagnostique et thérapeutique des rétinites nécrosantes herpétiques. J Fr Ophtalmol 2004; 27:223-36. [PMID: 15039624 DOI: 10.1016/s0181-5512(04)96124-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To study the viral cause and present the management of necrotizing herpetic retinopathies. METHODS Charts of patients presenting with acute retinal necrosis (ARN) or progressive outer retinal necrosis (PORN) diagnosed between March 1997 and June 2001 were retrospectively reviewed. Intraocular specimens were obtained in 33 cases to determine the viral cause using polymerase chain reaction-based assays and/or detection of intraocular antibody production. RESULTS The mean age was 43.4 Years. Herpesvirus genome was identified in 29 patients (80.5%). In the ARN group (32 patients, 38 eyes), herpes simplex virus (HSV) DNA was found in 11 patients (34.4%), varicella-zoster virus (VZV) in nine patients (28.1%), and cytomegalovirus (CMV) in four patients (12.5%). One patient (3.1%) presented an Epstein-Barr virus (EBV) infection. ARN was bilateral at initial examination in six patients and secondary bilateralization was observed in four patients. In the PORN group (four patients, eight eyes), the retinitis was bilateral and VZV DNA was detected in all cases. Two patients were treated with intravenous acyclovir, six with foscarnet alone, ten with intravenous foscarnet + acyclovir, 18 with intravenous foscarnet and intravitreous ganciclovir injections. Complications of necrotizing herpetic retinitis were cataract (26%), optic nerve atrophy (23.9%), and retinal detachment (17.4%). Final visual acuity was less or equal to 20/200 in 47.8% of cases. CONCLUSIONS It is important to determine the specific viral etiology since progression and prognosis may be different in herpetic necrotizing retinitis caused by HSV, VZV, or CMV. Visual prognosis is improved by intensive antiviral therapy, but remains poor if complications occur.
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Affiliation(s)
- T H C Tran
- Service d'Ophtalmologie, Hôpital Pitié Salpêtière, 47-83, boulevard de l'Hôpital, 75013 Paris
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Iino Y, Tanaka M, Hatano N, Kiyokawa M, Takebayashi H, Shinohara I, Kobayashi Y, Ninomiya H. A case of a five-year-old boy with acute retinal necrosis. Retina 2002; 22:225-8. [PMID: 11927861 DOI: 10.1097/00006982-200204000-00018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
MESH Headings
- Acyclovir/therapeutic use
- Antibodies, Viral/blood
- Antiviral Agents/therapeutic use
- Child, Preschool
- DNA, Viral/analysis
- Drug Therapy, Combination
- Enzyme-Linked Immunosorbent Assay
- Fluorescein Angiography
- Glucocorticoids/therapeutic use
- Herpes Zoster Ophthalmicus/diagnosis
- Herpes Zoster Ophthalmicus/drug therapy
- Herpes Zoster Ophthalmicus/virology
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Herpesvirus 3, Human/isolation & purification
- Humans
- Male
- Polymerase Chain Reaction
- Retinal Necrosis Syndrome, Acute/diagnosis
- Retinal Necrosis Syndrome, Acute/drug therapy
- Retinal Necrosis Syndrome, Acute/virology
- Visual Acuity
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Affiliation(s)
- Yutaka Iino
- Department of Ophthalmology, Juntendo University, Urayasu Hospital, Chiba, Japan
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