title: Herpes Simplex Acute Retinal Necrosis Presenting as Unilateral Disc Swelling in Young Immunocompetent Patients.
abstract: OBJECTIVE
  To report two cases of young immunocompetent males with herpes simplex acute retinal necrosis (HSV ARN) with initial diagnosis of unilateral disc swelling.
  
  
  METHODS
  Retrospective case series.
  
  
  RESULTS
  Two young immunocompetent males who were diagnosed to have unilateral disc swelling were treated as presumed optic neuritis and started on systemic steroids. On dilated fundal examination, unilateral retinitis and vasculitis was found after 2-3 days of systemic steroids and the diagnosis of ARN was made. Tetraplex vitreous tap subsequently returned as HSV-2 and HSV for the first and second patient, respectively. Both patients had no significant systemic medical history and tested negative for human immunodeficiency virus (HIV). Despite aggressive treatment, both patients developed profound visual morbidity.
  
  
  CONCLUSIONS
  Close monitoring of patients with unilateral disc swelling and dilated fundus evaluation is critical, particularly upon initiation of systemic steroid therapy, even if immunocompetent, as misdiagnoses can result in potentially devastating consequences.
authors.affiliation: a National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.
authors.forename: Yan Tong
authors.initials: YT
authors.lastname: Koh
authors.affiliation: a National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.
authors.forename: Bryan Chin-Hou
authors.initials: BC
authors.lastname: Ang
authors.affiliation: a National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.
authors.forename: Su Ling
authors.initials: SL
authors.lastname: Ho
authors.affiliation: a National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.|b Eagle Eye Center , Gleneagles Hospital , Singapore.
authors.forename: Stephen Charn
authors.initials: SC
authors.lastname: Beng Teoh
authors.affiliation: a National Healthcare Group Eye Institute, Tan Tock Seng Hospital , Singapore.|c Institute of Ophthalmology, University College London , London , UK.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D005451:Fluorescein Angiography; D006561:Herpes Simplex / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D008297:Male; D009902:Optic Neuritis / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology; D010211:Papilledema / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012189:Retrospective Studies; D014822:Vitreous Body / Q000821:virology
chemical_list: D000998:Antiviral Agents
keywords: Disc swelling; herpes simplex acute retinal necrosis; immunocompetent; optic neuritis; steroids