Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran.
Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Ophthalmol. 2021 Sep 16;21(1):337. doi: 10.1186/s12886-021-02096-x.
Acute retinal necrosis is considered a rare infectious uveitis. This condition is usually caused by varicella-zoster virus or herpes simplex virus. Acute retinal necrosis caused by co-infection with multiple viruses is extremely rare. Herein, we report a case of acute retinal necrosis caused by co-infection with herpes simplex virus (type I and II) and varicella-zoster virus (VZV) in a natalizumab-treated patient due to multiple sclerosis.
An adult man presented with a complaint of decreased vision of the right eye from 12 days ago. He was a known case of multiple sclerosis receiving natalizumab. Examination of the right eye revealed severe conjunctival injection, fine diffuse keratic precipitates, 3 + anterior chamber and vitreous cells, elevated intraocular pressure (26 mmHg), a blurred optic disk with hemorrhagic patches, and occlusive vasculitis plus confluent necrotizing patches in the peripheral retina compatible with diagnosis of acute retinal necrosis. He underwent anterior chamber and vitreous tap, and real-time PCR detected HSV I & II and VZV on the vitreous specimen. A second PCR showed the same result. After neurological consultation, natalizumab was discontinued and intravenous acyclovir was started followed by oral acyclovir and oral prednisolone to control the disease, which was successful.
Although rare, multiple-viral infection should be considered in the physiopathology of acute retinal necrosis, especially in immunosuppressed patients.
急性视网膜坏死被认为是一种罕见的感染性葡萄膜炎。这种情况通常由水痘带状疱疹病毒或单纯疱疹病毒引起。由多种病毒合并感染引起的急性视网膜坏死极为罕见。在此，我们报告一例由多发性硬化症接受那他珠单抗治疗的患者中单纯疱疹病毒（I 型和 II 型）和水痘带状疱疹病毒（VZV）合并感染引起的急性视网膜坏死。
一名成年男性因右眼视力下降 12 天就诊。他是一名已知的多发性硬化症接受那他珠单抗治疗的患者。右眼检查发现严重的结膜充血、细小弥漫性角膜后沉着物、前房和玻璃体 3+细胞、眼内压升高（26mmHg）、视盘模糊伴出血斑、周边视网膜闭塞性血管炎伴融合性坏死斑，符合急性视网膜坏死的诊断。他接受了前房和玻璃体液抽取，实时 PCR 在玻璃体液标本中检测到 HSV I & II 和 VZV。第二次 PCR 显示相同结果。经神经科会诊后，停用那他珠单抗，开始静脉用阿昔洛韦，随后口服阿昔洛韦和口服泼尼松龙控制疾病，病情得到成功控制。
尽管罕见，但应考虑急性视网膜坏死的发病机制中存在多种病毒感染，尤其是在免疫抑制患者中。
