Acute retinal necrosis diagnosed in a child with chronic panuveitis.
BACKGROUND
To report the case of an immunocompetent child with herpes simplex virus-2 (HSV-2) acute retinal necrosis (ARN) syndrome, who was considered to have an idiopathic unilateral panuveitis sensitive to steroid treatment.


METHODS
Polymerase chain reaction for detection of viral DNA was applied to ocular fluids and in situ hybridization was performed on a retinal sample. HSV serology was performed using the ELISA and Western blot techniques, and an in-house indirect immunofluorescence technique.


RESULTS
In addition to the atypical clinical presentation, the serological assays for HSV were negative using ELISA at the time of diagnosis of ARN and 1 year after. HSV2 infection was confirmed by using polymerase chain reaction of aqueous humor specimen and in situ hybridization of a retinal biopsy. Retrospective analysis with the Western blot technique detected low titers of anti-HSV antibodies, when the sera were concentrated 5-fold.


CONCLUSIONS
Herpes virus infections must be investigated in children with posterior or panuveitis. PCR analysis is a reliable technique for diagnosis. This case emphasizes that clinical presentation can be atypical and that a negative viral serology does not exclude an acute or a past herpetic infection.
Chiquet
Christophe
C
Department of Ophthalmology, Hôpital Michallon, CHU de Grenoble, BP217, Grenoble, Cedex 09, France. cchiquet@chu-grenoble.fr
Bodaghi
Bahram
B
Mougin
Christiane
C
Najioullah
Fatiha
F
D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D002675:Child, Preschool; D002908:Chronic Disease; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D017403:In Situ Hybridization; D008297:Male; D015864:Panuveitis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir