Khandwala Nikhila S, Miller Jason M L, Hyde Robert A, Conrady Christopher D, Rao Rajesh C, Besirli Cagri G
Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.
Case Rep Ophthalmol. 2021 Apr 12;12(1):164-168. doi: 10.1159/000513108. eCollection 2021 Jan-Apr.
We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient's clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.
我们报告了一例由单纯疱疹病毒2型（HSV-2）感染而非弓形虫引起的伴有急性视网膜坏死（ARN）的色素性脉络膜视网膜瘢痕，这造成了最初的诊断困境。一名53岁的功能性单眼男性在4天内，其患眼出现无痛性飞蚊症和视力模糊。检查发现前房（AC）反应、玻璃体炎、多灶性白色斑块以及闭塞性视网膜血管炎。在周边部可见一个上方有色素沉着的脉络膜视网膜瘢痕，伴有上方玻璃体收缩，且相邻视网膜无白色病变。该患者同时接受了ARN和弓形虫性脉络膜视网膜炎的治疗，直到玻璃体和AC的PCR检测结果显示HSV-2呈阳性，弓形虫病呈阴性。治疗方案包括口服和玻璃体内抗病毒药物以及口服皮质类固醇的双重治疗方案。患者的临床病程在症状出现后2周内并发了孔源性视网膜脱离，需要行玻璃体切除联合硅油填充术以及术中眼内注射膦甲酸。我们回顾了由HSV-2特异性引起的ARN中色素性脉络膜视网膜瘢痕的新证据，以及ARN和ARN性视网膜脱离治疗中的诊断和治疗困境。
