title: Bilateral central retinal artery occlusion associated with herpes simplex virus-associated acute retinal necrosis and meningitis: case report and literature review.
abstract: A 60-year-old woman with a history of recurrent headaches and blurred vision presented with bilateral optic disc edema. Optic neuritis was suspected, and intravenous methylprednisonlone was administered. Her vision declined to hand motions in both eyes, and subsequent evaluation revealed bilateral acute retinal necrosis with bilateral central retinal artery occlusions (CRAO). Aqueous humor polymerase chain reaction analysis was positive for herpes simplex virus (HSV), establishing a diagnosis of HSV-associated bilateral acute retinal necrosis (ARN) and meningitis. CRAO has rarely been reported in association with ARN, and a fulminant course with bilateral CRAO in association with ARN has not been previously reported. This case emphasizes the importance of careful peripheral examination in patients with presumptive optic neuritis, judicious use of systemic corticosteroid in this context, and the retinal vaso-obliterative findings that may be observed in the pathogenesis of ARN.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Weissman
authors.forename: Valerie
authors.initials: V
authors.lastname: Biousse
authors.forename: Marcos Coutinho
authors.initials: MC
authors.lastname: Schechter
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D001082:Aqueous Humor / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D004359:Drug Therapy, Combination; D015828:Eye Infections, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D005260:Female; D005451:Fluorescein Angiography; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006561:Herpes Simplex / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D018258:Herpesvirus 2, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D017245:Foscarnet; D015774:Ganciclovir