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.
Franco-Paredes
Carlos
C
Division of Infectious Diseases, Department of Medicine, Veterans Affairs Medical Center, Emory University School of Medicine, 69 Butler Street, Atlanta, GA 30303, USA.
Bellehemeur
Thomas
T
Merchant
Ali
A
Sanghi
Pramod
P
DiazGranados
Carlos
C
Rimland
David
D
D017088:AIDS-Related Opportunistic Infections / Q000821:virology*; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D018450:Disease Progression; D017245:Foscarnet / Q000627:therapeutic use; D006562:Herpes Zoster / Q000188:drug therapy / Q000209:etiology*; D006563:Herpes Zoster Ophthalmicus / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008582:Meningitis, Aseptic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D009494:Neurosyphilis / Q000175:diagnosis; D009902:Optic Neuritis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D015882:Retinal Necrosis Syndrome, Acute / Q000209:etiology* / Q000821:virology; D013256:Steroids; D013997:Time Factors; D014786:Vision Disorders / Q000209:etiology
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D013256:Steroids; D017245:Foscarnet