Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome.
OBJECTIVE
To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome.


METHODS
Case series.


METHODS
Two tertiary care centers in San Diego, Calif, and London, England.


METHODS
Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis.


RESULTS
All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment.


CONCLUSIONS
Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.
Friedlander
S M
SM
Department of Pathology, University of California, San Diego, La Jolla, USA.
Rahhal
F M
FM
Ericson
L
L
Arevalo
J F
JF
Hughes
J D
JD
Levi
L
L
Wiley
C A
CA
Graham
E M
EM
Freeman
W R
WR
Arrevalo
J F
JF
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D003872:Dermatitis / Q000188:drug therapy / Q000821:virology; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006562:Herpes Zoster / Q000188:drug therapy / Q000209:etiology; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D012160:Retina / Q000473:pathology / Q000821:virology; D015882:Retinal Necrosis Syndrome, Acute / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D017193:Skin Diseases, Viral / Q000188:drug therapy / Q000209:etiology; D014792:Visual Acuity; D014822:Vitreous Body / Q000473:pathology / Q000821:virology
D000956:Antigens, Viral; D000998:Antiviral Agents; D000212:Acyclovir