Makri Olga E, Tsekouras Iasonas K, Leonidou Leonidia, Kagkelaris Konstantinos, Kozobolis Vassilios, Georgakopoulos Constantinos D
Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece.
Internal Medicine, Department of Internal Medicine, Patras University Hospital, 265 04 Patras, Greece.
Vision (Basel). 2022 May 18;6(2):27. doi: 10.3390/vision6020027.
We report the case of a 52-year-old woman who presented to the emergency department with acute retinal necrosis in her left eye secondary to herpes simplex virus type 1 encephalitis for which she had been hospitalized four months before. Treatment with intravitreal foscarnet and intravenous acyclovir was promptly commenced followed by the addition of oral prednisolone. PCR analysis of aqueous humor detected HSV type 1 DNA. The condition responded to therapy with partial resolution of intraocular inflammation and improvement of visual acuity, but the presence of Kyrieleis plaques was observed two weeks after the initiation of treatment, when five intravitreal foscarnet injections had been administered. The patient was switched to oral therapy with valacyclovir, and 10 weeks after commencing treatment, the patient's left eye was free of inflammation, having achieved a BCVA of 20/20. Oral steroid treatment was gradually tapered off, and the patient was instructed to remain on prophylactic antiviral therapy. Kyrieleis arteriolitis is an uncommon finding in the context of acute retinal necrosis. As far as we are aware, we report the first case of Kyrieleis arteriolitis in acute retinal necrosis secondary to viral encephalitis and the second one presenting Kyrieleis plaques in acute retinal necrosis caused by herpes simplex virus type 1. Prior reports of cases of Kyrieleis arteriolitis in acute retinal necrosis are also presented.
我们报告了一例52岁女性病例，该患者因单纯疱疹病毒1型脑炎继发左眼急性视网膜坏死而前往急诊科就诊，她在四个月前曾因该脑炎住院治疗。立即开始玻璃体内注射膦甲酸钠和静脉注射阿昔洛韦治疗，随后加用口服泼尼松龙。房水的PCR分析检测到单纯疱疹病毒1型DNA。病情对治疗有反应，眼内炎症部分消退，视力改善，但在开始治疗两周后，在已进行5次玻璃体内膦甲酸钠注射时，观察到了基里尔斑。患者改用伐昔洛韦口服治疗，开始治疗10周后，患者左眼无炎症，最佳矫正视力达到20/20。口服类固醇治疗逐渐减量，患者被指示继续进行预防性抗病毒治疗。基里尔小动脉炎在急性视网膜坏死的情况下是一种罕见的发现。据我们所知，我们报告了第一例继发于病毒性脑炎的急性视网膜坏死合并基里尔小动脉炎的病例，以及第二例由单纯疱疹病毒1型引起的急性视网膜坏死出现基里尔斑的病例。还介绍了先前急性视网膜坏死合并基里尔小动脉炎病例的报告。
