Wang Daniel, Bloomberg Justin D, Sobrin Lucia, Goldstein Debra, Skondra Dimitra
Department of Ophthalmology, New York Eye and Ear Infirmary, 310 E. 14th Street, New York, NY, USA.
Department of Ophthalmology, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Avenue, Chicago, IL, USA.
Am J Ophthalmol Case Rep. 2019 Jun 20;15:100501. doi: 10.1016/j.ajoc.2019.100501. eCollection 2019 Sep.
To report the unique clinical findings of a case of Herpes Simplex Virus Type 2 herpetic retinitis manifesting as a large elevated subretinal lesion.
A 26-year-old Hispanic male with no significant past medical history presented with a one-week history of right eye pain and endorsement of worsening vision. Ophthalmic examination of the right eye identified a markedly elevated white subretinal lesion with associated findings of vitritis and hypotony. Ultrasound biomicroscopy demonstrated a diffusely thickened choroid and confirmed the observed subretinal mass. Examination of the fellow left eye was largely unremarkable with the exception of lesions suggestive of inactive chorioretinal scars. Diagnostic vitrectomy and vitreous PCR (polymerase chain reaction) was positive only for HSV-2 (herpes simplex virus type 2) and verified by two independent laboratories. The observed subretinal lesion of right eye improved on intravenous acyclovir and intravitreal foscarnet treatment.
Presented here is an unusual, novel clinical presentation of HSV-2 acute retinal necrosis manifesting as an elevated subretinal lesion along with findings of panuveitis. This case suggests that consideration should be given to the diagnosis of HSV ARN (acute retinal necrosis) when a subretinal elevation is concomitantly appreciated in the setting of vitritis and chorioretinal lesions.
报告1例表现为巨大视网膜下隆起病变的2型单纯疱疹病毒性视网膜炎的独特临床发现。
一名26岁无重大既往病史的西班牙裔男性，出现右眼疼痛1周并伴有视力恶化。右眼眼科检查发现一个明显隆起的白色视网膜下病变，并伴有玻璃体炎和低眼压的相关表现。超声生物显微镜检查显示脉络膜弥漫性增厚，并证实了观察到的视网膜下肿块。除了提示非活动性脉络膜视网膜瘢痕的病变外，对侧左眼检查基本正常。诊断性玻璃体切除术和玻璃体聚合酶链反应（PCR）仅对2型单纯疱疹病毒（HSV-2）呈阳性，并经两个独立实验室验证。右眼观察到的视网膜下病变在静脉注射阿昔洛韦和玻璃体内注射膦甲酸治疗后有所改善。
本文介绍了1例不寻常的新型2型单纯疱疹病毒急性视网膜坏死临床表现，表现为视网膜下隆起病变并伴有全葡萄膜炎表现。该病例表明，当在玻璃体炎和脉络膜视网膜病变的背景下同时发现视网膜下隆起时，应考虑诊断为HSV急性视网膜坏死（ARN）。
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