Two patients with the von Szily reaction: herpetic keratitis and contralateral retinal necrosis.
OBJECTIVE
To present two patients with prior unilateral, herpetic keratitis who developed acute retinal necrosis (ARN) in the contralateral eye. These cases have noticeable similarities to the von Szily reaction. This describes the development of a contralateral retinitis subsequent to an anterior chamber injection of herpes simplex virus (HSV).


METHODS
Interventional case series.


METHODS
Retrospective chart and literature review.


RESULTS
The first patient had neonatally acquired herpetic keratitis and developed ARN at age 21. Polymerase chain reaction of a vitreous biopsy detected HSV type-2 (HSV-2). The second patient was clinically diagnosed with ARN contralateral to varicella zoster keratitis. A detailed literature search located seven prior case reports with a von Szily reaction. These resembled our two cases except none had HSV-2 or years of latency from keratitis to retinitis.


CONCLUSIONS
Clinicians need to be cognizant of the von Szily reaction.
Smith
Lynnelle K
LK
Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA.
Kurz
Paul A
PA
Wilson
David J
DJ
Flaxel
Christina J
CJ
Rosenbaum
James T
JT
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003519:Cyclopentolate / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000302:isolation & purification; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D016849:Keratitis, Herpetic / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D012189:Retrospective Studies; D013999:Timolol / Q000627:therapeutic use; D014822:Vitreous Body / Q000821:virology
D000998:Antiviral Agents; D005938:Glucocorticoids; D013999:Timolol; D003519:Cyclopentolate