[Bilateral acute retinal necrosis syndrome associated with meningoencephalitis caused by herpes simplex virus 2. A case report].
BACKGROUND
Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features.


METHODS
We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached.


CONCLUSIONS
ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.
Cardine
S
S
Service d'Ophtalmologie, Centre hospitalier Robert Ballanger, Aulnay sous Bois.
Chaze
P A
PA
Bourcier
F
F
Amara
N
N
Prevost
G
G
Ruhomauly
H
H
Garandeau
C
C
Maisonneuve
L
L
Benzacken
L
L
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D002555:Cerebrospinal Fluid / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D003951:Diagnostic Errors; D004359:Drug Therapy, Combination; D020803:Encephalitis, Herpes Simplex / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006429:Hemiplegia / Q000209:etiology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012163:Retinal Detachment / Q000209:etiology; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D020521:Stroke / Q000175:diagnosis; D014549:Urinary Incontinence / Q000209:etiology; D014775:Virus Activation
D000998:Antiviral Agents; D004279:DNA, Viral; D003907:Dexamethasone; D015774:Ganciclovir; D000212:Acyclovir