Herpes simplex virus type 2 acute retinal necrosis in an immunocompetent patient.
OBJECTIVE
To report a case of acute retinal necrosis caused by herpes simplex virus 2 in an otherwise healthy patient.


METHODS
A 45-year-old man presented with one month's history of decreased vision in the right eye. He had previously received a course of intravenous gancyclovir because of a clinical suspicion of cytomegalovirus retinitis. The patient's ocular history was remarkable for a similar episode in the left eye thirty years earlier, resulting in important visual impairment. System and laboratory investigations were unremarkable. Ocular examination showed severe anterior granulomatous uveitis, vitreous haze, areas of necrosis and retinal exudates. The anterior chamber tap disclosed the presence of HSV type 2, and oral steroids and acyclovir were instituted. Two weeks after the patient had been discharged, a retinal detachment occurred in the right eye, necessitating surgical repair. The presence of HSV type 2 was confirmed in the vitreous. Visual acuity recovered completely after surgery and the patient was placed on a maintenance dose of oral acyclovir.


CONCLUSIONS
HSV type 2 is a rare cause of acute retinal necrosis in healthy patients. Bilateral involvement can occur in the fellow eye, even with a long delay. Acute retinal necrosis is a severe ocular inflammatory syndrome associated with a very poor visual outcome. It is caused by VZV, HSV type 1 and, less commonly, by HSV type 2. The disease can affect healthy patients and cause bilateral involvement in the fellow eye, even with a long delay.
Miserocchi
E
E
Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milano, Italy.
Modorati
G
G
Azzolini
C
C
Foster
C S
CS
Brancato
R
R
D000867:Anterior Chamber / Q000821:virology; D000998:Antiviral Agents / Q000627:therapeutic use; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000188:drug therapy / Q000821:virology; D005654:Fundus Oculi; D015774:Ganciclovir / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006561:Herpes Simplex / Q000188:drug therapy / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011239:Prednisolone / Q000627:therapeutic use; D012163:Retinal Detachment / Q000601:surgery / Q000821:virology; D015882:Retinal Necrosis Syndrome, Acute / Q000821:virology*; D016896:Treatment Outcome; D014792:Visual Acuity; D014822:Vitreous Body / Q000821:virology
D000998:Antiviral Agents; D004279:DNA, Viral; D005938:Glucocorticoids; D011239:Prednisolone; D015774:Ganciclovir