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接种疫苗儿童的水痘相关性视网膜炎和闭塞性血管炎:病例报告及文献综述

Chickenpox Associated Retinitis and Occlusive Vasculitis in a Vaccinated Child: A Case Report and Literature Review.

作者信息

Ozcan Gokcen, Temel Emine, Yalcindag Nilufer, Ince Erdal, Kiziltunc Pinar Bingol, Ince Elif, Atilla Huban

机构信息

Department of Ophthalmology, Ankara University, Ankara, Turkey.

Department of Pediatric Infectious Disease, Ankara University, Ankara, Turkey.

出版信息

Beyoglu Eye J. 2022 May 27;7(2):143-149. doi: 10.14744/bej.2022.50490. eCollection 2022.

Abstract

Either retinitis and occlusive vasculitis are rare but vision threatening ocular complications of chickenpox in children. In this case report a 13-year-old girl who developed chickenpox 2 days before complaining with visual loss in her right eye is presented. She was vaccinated one dose of varicella zoster virus (VZV) vaccine when she was 12 months old. Best corrected visual acuity was counting fingers at 1.5 m in right eye. A subtle anterior segment inflammation and mild vitritis were observed. Fundoscopic examination of right eye showed ischemia in paracentral macula and white foci of retinitis along the superotemporal branch of retinal vessels. She was hospitalized and intravenous acyclovir treatment at 3 × 10 mg/kg daily dose was started. Serum IgM and IgG for VZV were positive. Aqueous humor PCR test was also reported positive for VZV DNA. Oral methylprednisolone was added at a dose of 64 mg/day at the 3 day acyclovir treatment. Macular edema developed at 4 week of treatment and bevacizumab was administered intravitreally. After 3 injections retinal edema subsided completely. At 6-month follow-up retinal ischemia in superotemporal periphery was observed and photocoagulation was added to treatment.

摘要

视网膜炎和闭塞性血管炎均为儿童水痘罕见但威胁视力的眼部并发症。在本病例报告中,介绍了一名13岁女孩,她在出现右眼视力丧失前两天患了水痘。她在12个月大时接种了一剂水痘带状疱疹病毒(VZV)疫苗。右眼最佳矫正视力为在1.5米处数指。观察到轻微的前段炎症和轻度玻璃体炎。右眼眼底检查显示黄斑中心凹旁缺血以及沿视网膜血管颞上分支的视网膜白色病灶。她住院治疗,开始静脉注射阿昔洛韦,每日剂量为3×10mg/kg。VZV的血清IgM和IgG呈阳性。房水PCR检测也报告VZV DNA呈阳性。在阿昔洛韦治疗第3天时加用口服甲泼尼龙,剂量为64mg/天。治疗4周时出现黄斑水肿,遂行玻璃体腔内注射贝伐单抗。3次注射后视网膜水肿完全消退。在6个月随访时,观察到颞上周边视网膜缺血,于是在治疗中增加了光凝治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1e0c/9169136/342a5b682bbf/BEJ-7-143-g001.jpg

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