1/41. HSV-1--induced acute retinal necrosis syndrome presenting with severe inflammatory orbitopathy, proptosis, and optic nerve involvement.OBJECTIVE: To present a unique case in which orbital inflammation, proptosis, and optic neuritis were the initial symptoms of acute retinal necrosis (ARN). The clinical presentation of ARN, as well as the currently recommended diagnostic procedures and guidelines for medical treatment of ARN, are summarized. DESIGN: Interventional case report. TESTING: polymerase chain reaction (PCR) techniques were made on the vitreous for cytomegalovirus, Epstein-Barr virus, herpes simplex virus (HSV), varicella zoster virus, and toxoplasmosis. A full laboratory evaluation was made together with HLA-typing and serologic tests measuring convalescent titers for HSV and other micro-organisms. magnetic resonance imaging scan, computed tomography (CT) scan, and fluorescein angiographic examination were performed. The patient was treated with acyclovir and oral prednisone. MAIN OUTCOME MEASURES: The patient was evaluated for initial and final visual acuity and for degree of proptosis, periocular edema, and vitreitis. RESULTS: The first symptoms and signs of ARN were eye pain, headache, proptosis, and a swollen optic nerve on CT scan. Other than increased c-reactive protein, all blood samples were normal. PCR was positive for HSV-type I in two separate vitreous biopsies. The patient had the strongly ARN-related specificity HLA-DQ7. CONCLUSIONS: This is the first report of HSV-induced ARN presenting with inflammatory orbitopathy and optic neuritis. polymerase chain reaction for HSV-1 was positive more than 4 weeks after debut of symptoms, which is a new finding. The combination of severe vitreitis and retinal whitening, with or without proptosis, should alert the clinician to the possibility of herpes infection and treatment with intravenous acyclovir started promptly.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/41. Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome.OBJECTIVE/BACKGROUND: To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. death occurred after failure of multiple organs. DESIGN: Case report. methods: Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. MAIN OUTCOME MEASURE: immunohistochemistry. RESULTS: All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. CONCLUSIONS: PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
3/41. Acute retinal necrosis following contralateral herpes zoster ophthalmicus.BACKGROUND: A case report of contralateral acute retinal necrosis (ARN) following herpes zoster ophthalmicus. CASE: A 61-year-old male patient developed iridocyclitis and well-demarcated creamy-white retinal lesions at the nasal periphery in the right eye 1 month after herpes zoster ophthalmicus in the left eye. The patient had undergone surgery for primary lung cancer, and had subsequent intracranial metastasis of the tumor. OBSERVATIONS: The clinical diagnosis of ARN was supported by polymerase chain reaction investigation of the aqueous humor resulting in positive for varicella-zoster virus. Retinal lesions disappeared after systemic treatment with acyclovir, corticosteroids, and acetylsalicylate. No retinal detachment developed. CONCLUSIONS: We propose a careful ophthalmic follow-up for herpes zoster ophthalmicus patients because of the possibility of acute retinal necrosis developing in the contralateral eye.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
4/41. Sight-threatening varicella zoster virus infection after fludarabine treatment.Varicella zoster virus (VZV) infection involving the posterior segment of the eye after fludarabine treatment has not previously been described. Two patients, who had completed fludarabine treatment 3 and 18 months previously, presented with visual loss that had been preceded by a recent history of cutaneous zoster. The use of the polymerase chain reaction (PCR) for VZV dna from ocular specimens allowed rapid confirmation of clinical diagnosis and treatment with a good outcome in one patient. With the increasing use of fludarabine and other purine analogues, an awareness of such complications is important because of their potentially sight-threatening consequences.- - - - - - - - - - ranking = 4keywords = varicella (Clic here for more details about this article) |
5/41. optic chiasm, optic nerve, and retinal involvement secondary to varicella-zoster virus.Immunocompromised patients are known to be at risk for varicella-zoster virus reactivation, often in atypical manners. We describe a 30-year-old man with simultaneous involvement of the retina, optic chiasm, and optic nerve with varicella-zoster virus who had a bitemporal visual field defect.- - - - - - - - - - ranking = 6keywords = varicella (Clic here for more details about this article) |
6/41. Acute retinal necrosis syndrome complicating chickenpox.chickenpox may be complicated by ocular involvement. In these patents, acute retinal necrosis usually forms a relatively mild course. Systemic antiviral treatment during the acute phase of the disease is recommended. Rarely, retinal detachment may develop, resulting in blindness. It is strongly recommended that patients with chickenpox who develop visual symptoms should be referred for an ophthalmological opinion early.- - - - - - - - - - ranking = 23.466044156503keywords = chickenpox (Clic here for more details about this article) |
7/41. Optic neuropathy and central retinal vascular obstruction as initial manifestations of acute retinal necrosis.BACKGROUND: The purpose of this brief communication is to alert ophthalmologists that optic neuropathy may herald acute retinal necrosis (ARN). CASE: A previously healthy 54-year-old man exhibited optic neuropathy as an initial presentation of ARN, 8 weeks after varicella-zoster dermatitis. OBSERVATIONS: Central retinal vascular obstruction developed subsequently in his left eye. Later, the classic presentation of ARN appeared in his contralateral eye. Systemic acyclovir therapy stopped the progression of retinitis and resulted in healing of retinal lesions in his right eye. CONCLUSIONS: This case suggests that optic neuropathy, especially with preceding herpetic dermatitis, should be suspected as the prodrome of ARN.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
8/41. Acute retinal necrosis syndrome in a child.We recently cared for an 11-year-old child with acute retinal necrosis syndrome, an ophthalmologic condition characterized by the triad of anterior uveitis, occlusive retinal vasculitis and progressive peripheral retinal necrosis. Acute retinal necrosis syndrome occurs primarily in nonimmunocompromised adults as a result of reactivated herpes simplex or varicella-zoster virus infection. Antiviral and antiinflammatory therapy appears to reduce the incidence of vision-threatening retinal necrosis and involvement of the contralateral eye.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
9/41. Aseptic meningitis and optic neuritis preceding varicella-zoster progressive outer retinal necrosis in a patient with AIDS.Varicella-Zoster Virus (VZV) is the second most common ocular pathogen in patients with hiv infection. VZV retinitis is estimated to occur in 0.6% of patients with hiv infection and may occur in one of two clinical syndromes. The first is the acute retinal necrosis syndrome, which also may be seen in immunocompetent hosts. The second clinical syndrome occurs in patients with CD4 cell counts typically < 50 x 10(6)/l and is termed progressive outer retinal necrosis. VZV retinitis has been reported to occur simultaneously with other VZV central nervous system manifestations such as encephalitis and myelitis in hiv-infected patients. In addition, VZV retrobulbar optic neuritis heralding VZV retinitis has recently been described in hiv-infected patients who had suffered a recent episode of dermatomal herpes zoster. Herein we report the case of an hiv-infected individual who presented with VZV meningitis and retrobulbar optic neuritis that preceded the onset of progressive outer retinal necrosis. We also review of the literature of seven additional reported cases of retrobulbar optic neuritis preceding the onset of VZV retinitis.- - - - - - - - - - ranking = 4keywords = varicella (Clic here for more details about this article) |
10/41. Unilateral varicella zoster virus ophthalmicus and contralateral acute retinal necrosis.We report two patients who developed varicella zoster virus (VZV) ophthalmicus complicated by ipsilateral keratouveitis, and within 4 weeks developed acute retinal necrosis (ARN) in the contralateral eye. The ipsilateral retina was spared in each case. One patient had systemic lupus erythematosus (SLE) and the other Hodgkin's disease. Both patients were in remission at the time of presentation.- - - - - - - - - - ranking = 5keywords = varicella (Clic here for more details about this article) |
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