title: Acquired immunodeficiency syndrome--associated herpes simplex virus retinitis. Clinical description and use of a polymerase chain reaction--based assay as a diagnostic tool.
abstract: OBJECTIVE
  To describe 2 patients with acquired immunodeficiency syndrome who experienced a rapidly progressive, bilateral retinitis due to herpes simplex virus (HSV) (1 case due to HSV type 1 [HSV-1] and 1 case due to HSV type 2 [HSV-2] and to present a novel diagnostic polymerase chain reaction (PCR)-based assay.
  
  
  METHODS
  The presentation, clinical course, and diagnostic PCR-based assay used to make the diagnosis of HSV retinitis in 2 patients with acquired immunodeficiency syndrome are described.
  
  
  RESULTS
  Both patients experienced a rapidly progressive, bilateral retinal necrosis associated with intraretinal hemorrhages and a diffuse vasculitis. The PCR-based assays demonstrated HSV DNA in the vitreous specimens from the 2 patients. Restriction analysis on the amplified DNA showed HSV-1 in 1 patient and HSV-2 in the second patient. The diagnosis was supported in both patients by the occurrence of a herpes simplex-like encephalitis, and in 1 patient by a positive vitreous culture. The HSV-1-associated vasculitis affected primarily the retinal arterioles, with marked capillary dropout and occlusion of larger arcade vessels. In contrast, the HSV-2-associated vasculitis affected the retinal veins more than the arterioles, and was associated with an exudative retinal detachment.
  
  
  CONCLUSIONS
  To our knowledge, these are the first 2 patients with acquired immunodeficiency syndrome in whom HSV has been implicated as the sole cause of a rapidly progressing, necrotizing retinitis. Combined PCR and restriction analysis of vitreous samples from such patients is a useful and highly specific means of diagnosing HSV-1 and HSV-2 retinitis.
authors.affiliation: Francis I. Proctor Foundation, School of Medicine, University of California-San Francisco, USA.
authors.forename: E T
authors.initials: ET
authors.lastname: Cunningham
authors.forename: G A
authors.initials: GA
authors.lastname: Short
authors.forename: A R
authors.initials: AR
authors.lastname: Irvine
authors.forename: J S
authors.initials: JS
authors.lastname: Duker
authors.forename: T P
authors.initials: TP
authors.lastname: Margolis
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001483:Base Sequence; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D018259:Herpesvirus 1, Human / Q000235:genetics* / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods*; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014822:Vitreous Body / Q000821:virology
chemical_list: D000998:Antiviral Agents; D017931:DNA Primers; D004279:DNA, Viral