Herpes simplex virus type 2 as a cause of acute retinal necrosis syndrome in young patients☆
Section snippets
Patient population
Ten patients with a clinical diagnosis of ARN syndrome, from whom intraocular fluid could be obtained, were recruited from four centers. Five patients were recruited at Emory University in Atlanta (patients 5, 6, 7, 8, and 9), two from Bascom Palmer Eye Institute (patients 3 and 4), two from Jules Stein Eye Institute (patients 1 and 2), and one from Detroit, Michigan (patient 10). Vitreous samples were obtained at the time of surgery for repair of retinal detachment. Aqueous samples were
Patient population
Patient demographics and clinical presentations of ARN syndrome in the 10 patients studied are shown in Table 1. The patients studied ranged in age from 15 to 65 years at the time of diagnosis. None of the patients had evidence of underlying immunocompromised status at presentation. At presentation, all had the classic manifestations of ARN syndrome defined by the American Uveitis Society criteria.4 Seven patients had bilateral ARN syndrome, but none of these patients had fluid removed from
Discussion
Measurement of intraocular antibody titers and calculation of modified Witmer coefficients identified a probable causal agent for ARN syndrome in 9 of the 10 patients tested. In these nine patients, a clear increase in relative antibody levels to one virus compared with all others was observed. Immunoglobulin A testing confirmed the diagnosis suggested by the IgG testing in each of the five cases in which it was performed. Two viruses, HSV-2 and VZV, accounted for all cases. Interestingly, of
Acknowledgements
The authors thank William W. Culbertson, Mary L. Lewis, Mark S. Blumenkranz, and Gary Cowan, for contributing patient samples and histories to this study, and Allan E. Kreiger, Lindsey Reese, Andre Nahmias, and Francis K. Lee for analysis of the intraocular specimens. The authors also thank Fei Yu, of the Center for Eye Epidemiology of the Jules Stein Eye Institute, for assistance with statistical analyses performed in this study.
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2018, American Journal of OphthalmologyCitation Excerpt :The higher percentage of eyes with a clinical diagnosis alone in the intravenous group (and, consequently lower rate of eyes with PCR-confirmed VZV ARN) might be explained by the fact that intraocular fluid aspiration and PCR was not performed as commonly in earlier practice as it is today. Given that VZV has been shown to be the most common causative agent of ARN,1,25–27 it is likely that the majority of eyes diagnosed clinically with ARN (without confirmatory PCR) also had VZV-related ARN. In accordance with the literature,25,26 this study found that HSV-related ARN occurred on average at a younger age (27.4 years) than VZV ARN (53.6 years).
A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease
2018, American Journal of Ophthalmology Case ReportsCitation Excerpt :HSV type 2 is a common cause of sexually transmitted infection of the genital area, but is uncommonly encountered in the eye. When it is present in the eye, it usually manifests in the posterior segment, with uveitis and acute retinal necrosis.3 HSV type 2 in the anterior segment is extremely rare, but has been reported to cause keratitis in infants who were infected through a placental or maternal genital tract route. 4,5
Infective Uveitis, Retinitis, and Chorioretinitis
2018, Principles and Practice of Pediatric Infectious DiseasesViral posterior uveitis
2017, Survey of Ophthalmology
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Supported by Research to Prevent Blindness, Inc., New York, New York (RNVG, GNH); the Heed Ophthalmic Foundation (RNVG), Cleveland, Ohio; the Bernard Becker Clinician–Scientist Award (RNVG), St. Louis, Missouri; and the David May II Endowed Professorship (GNH), UCLA, Los Angeles, California. Dr. Van Gelder is recipient of a Career Development Award, and Dr. Holland is a recipient of a Lew R. Wasserman Merit Award from Research to Prevent Blindness, Inc., New York, New York. Dr. Henry Kaplan, Evans Professor of Ophthalmology, Louisville, Kentucky.