CASE REPORT

A previously healthy 30 year old Portuguese woman was admitted complaining of progressive visual loss in both eyes, over 2 weeks, associated with headaches and pain on eye movements and meningismus. Symptoms appeared 24 hours after the beginning of a flu-like syndrome. The patient had no past history of ocular trauma or surgery. On examination, the visual acuity was 20/100 in both eyes. Slit-lamp examination revealed 2+ cells in both anterior chambers with non-granulomatous keratic precipitates. Intraocular pressure was 10 mm Hg in both eyes. There were 1+ cells in the anterior vitreous of both eyes. Fundus examination revealed a bilateral papilloedema and the fluorescein angiography showed focal areas of leakage at the level of the retinal pigment epithelium and staining of the optic disc (Fig 1A, B).

The initial clinical examination revealed an erythrocyte sedimentation rate of 10 mm in the first hour (normal range 1–12), a white blood count of 4.2 g/l (normal range 4–11 g/l) with a normal differential count. Chest x ray was normal. A lumbar puncture showed a lymphocytic pleocytosis (proteins 0.37 g/l, white cells 77×10⁶/l, lymphocytes 96%), without oligoclonal bands on electrophoresis. A magnetic resonance cerebral scan was normal. Suspecting a herpetic infection, aciclovir …