title: Varicella Zoster Virus Necrotizing Retinitis in Two Patients with Idiopathic CD4 Lymphocytopenia.
abstract: OBJECTIVE
  Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia.
  
  
  METHODS
  Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented.
  
  
  RESULTS
  An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm(3). A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm(3).
  
  
  CONCLUSIONS
  VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.
authors.affiliation: a Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA .
authors.forename: Meenakashi
authors.initials: M
authors.lastname: Gupta
authors.affiliation: b Texas Diabetes Institute, Department of Ophthalmology, University of Texas Health Sciences Center , San Antonio , Texas , USA .
authors.forename: Maria Stephanie R
authors.initials: MS
authors.lastname: Jardeleza
authors.affiliation: c Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA .
authors.forename: Ivana
authors.initials: I
authors.lastname: Kim
authors.affiliation: d Department of Infectious Disease , Massachusetts General Hospital , Boston , Massachusetts , USA , and.
authors.forename: Marlene L
authors.initials: ML
authors.lastname: Durand
authors.affiliation: c Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA .
authors.forename: Leo
authors.initials: L
authors.lastname: Kim
authors.affiliation: e Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Lobo
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005451:Fluorescein Angiography; D018023:HIV Seronegativity; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008231:Lymphopenia / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D041623:Tomography, Optical Coherence; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014821:Vitrectomy
chemical_list: D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir
keywords: Herpetic retinopathy; idiopathic CD4 lymphocytopenia; immunosuppression; progressive outer retinal necrosis