title: Two patients with the von Szily reaction: herpetic keratitis and contralateral retinal necrosis.
abstract: 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.
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: Lynnelle K
authors.initials: LK
authors.lastname: Smith
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurz
authors.forename: David J
authors.initials: DJ
authors.lastname: Wilson
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Flaxel
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
mesh_terms: 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
chemical_list: D000998:Antiviral Agents; D005938:Glucocorticoids; D013999:Timolol; D003519:Cyclopentolate