Vasudevan Archana, Rojas-Moreno Christian, Tarun Tushar
Division of Infectious Diseases, Department of Medicine, University of Missouri, One Hospital Drive, Columbia, MO, 65212, United States.
Division of Cardiology, Department of Medicine, University of Missouri, One Hospital Drive, Columbia, MO, 65212, United States.
IDCases. 2019 Jul 12;18:e00585. doi: 10.1016/j.idcr.2019.e00585. eCollection 2019.
A 54 year old female presented to the ophthalmology clinic with pain and decreased vision in her left eye. No past medical history other than primary varicella zoster infection, in her childhood. The eye exam revealed a macular region with scattered areas of retinal opacity along with patches of necrosis on the periphery. She was started on valganciclovir and referred to the infectious disease clinic. Cell Count, blood chemistry and HIV were negative. Serum was sent for polymerase chain reaction (PCR) for Varicella Zoster Virus (VZV), Herpes Simplex Virus (HSV) and Cytomegalovirus (CMV). The VZV PCR was positive. She had decreased vision on the right eye two days later, and exam revealed peripheral retinal whitening. She was admitted and started on intravenous acyclovir. VZV is one of the most common causes of ARN and has been described in both immunocompetent and immunocompromised persons. Visual changes are usually noted weeks to months after the antecedent herpes zoster. Retinal involvement is bilateral in over half of cases, suggesting that VZV reaches the central nervous system hematogenously. The retinal exam reveals multifocal necrotizing lesions, often initially involving the peripheral retina. Therapy includes intravenous acyclovir with consideration of intravitreal foscarnet and other antivirals for progressing disease.
一名54岁女性因左眼疼痛和视力下降就诊于眼科门诊。除了童年时期患过原发性水痘带状疱疹感染外，无其他既往病史。眼部检查发现黄斑区有散在的视网膜混浊区域，周边还有坏死斑。她开始服用缬更昔洛韦，并被转诊至传染病门诊。血细胞计数、血液化学检查和HIV检测均为阴性。采集血清进行水痘带状疱疹病毒（VZV）、单纯疱疹病毒（HSV）和巨细胞病毒（CMV）的聚合酶链反应（PCR）检测。VZV的PCR检测呈阳性。两天后她右眼视力下降，检查发现周边视网膜变白。她入院并开始静脉注射阿昔洛韦。VZV是急性视网膜坏死（ARN）最常见的病因之一，在免疫功能正常和免疫功能低下的人群中均有报道。视力变化通常在带状疱疹发作数周数月后出现。超过半数病例的视网膜病变为双侧性，提示VZV通过血液传播至中枢神经系统。视网膜检查发现多灶性坏死性病变，通常最初累及周边视网膜。治疗包括静脉注射阿昔洛韦，对于病情进展者可考虑玻璃体内注射膦甲酸钠及其他抗病毒药物。
