Catastrophic acute retinal necrosis syndrome associated with diffuse orbital cellulitis: a case report.
BACKGROUND
To report a case of severe acute retinal necrosis syndrome (ARN) associated with initial features of orbital cellulitis.


METHODS
A 49-year-old immunocompetent woman presented with unilateral painful orbital inflammation associated with deep visual loss due to ARN. Polymerase chain reaction (PCR) for detection of viral DNA was applied to ocular fluids. Immunohistochemistry for detection of viral antigens and histopathologic studies were performed on orbital biopsy specimens.


RESULTS
HSV-2 DNA was detected by PCR in ocular fluids. Orbital biopsy disclosed non-specific inflammation without viral replication. Orbital inflammation resolved rapidly after the initiation of antiviral drugs, whereas intraocular inflammation worsened. Final ophthalmic examination disclosed no light perception due to optic atrophy.


CONCLUSIONS
ARN and cellulitis may be associated. Consequently, ARN should be investigated in all patients with orbital inflammation, in order to initiate immediately an appropriate antiviral strategy.
Rozenbaum
Olivier
O
Department of Ophthalmology, University of Paris VI Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Rozenberg
Flore
F
Charlotte
Frederic
F
Bodaghi
Bahram
B
D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D002481:Cellulitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006561:Herpes Simplex / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009916:Orbital Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D000914:Antibodies, Viral; D000956:Antigens, Viral; D000998:Antiviral Agents; D004279:DNA, Viral