Oshitari K, Arimoto H, Suzuki S, Oguchi Y
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.
Nippon Ganka Gakkai Zasshi. 1994 Nov;98(11):1141-6.
We report a case of rapidly progressive varicella zoster virus retinitis, which is distinct from acute retinal necrosis syndrome. The patient was a 52-year-old male and suffered acquired immunodeficiency syndrome. Two months after the varicella zoster dermatitis in the distribution of the first division of the left trigeminal nerve, pseudodendritic keratitis and iridocyclitis were observed in the left eye. After 5 weeks, multifocal and patchy white exudates were observed in the peripheral deeper layer of the retina in the left eye, but retinal vasculitis in the exudative lesions was slight. Despite systemic administration of acyclovir, white exudates progressed confluently from the periphery to the post pole of the retina and reached the macula in 10 weeks. Eight weeks after the observation of lesions in the left eye, we found the same lesions in the right eye. After the white exudative lesions disappeared, the retina became atrophic and the retinal vessels were narrowed, but no retinal detachment was observed. Recently, Foster and associates described the rapidly progressive outer retinal necrosis as a new entity of varicella zoster virus retinitis in AIDS patients. We think our case was very similar to the rapidly progressive outer retinal necrosis. This case shows that we must carefully follow up the rapidly progressive outer retinal necrosis in the AIDS patients with a varicella zoster dermatitis.
我们报告一例快速进展性水痘带状疱疹病毒视网膜炎，它与急性视网膜坏死综合征不同。患者为一名52岁男性，患有获得性免疫缺陷综合征。在左侧三叉神经第一分支分布区出现水痘带状疱疹性皮炎两个月后，左眼观察到假树枝状角膜炎和虹膜睫状体炎。5周后，左眼视网膜周边深层观察到多灶性和片状白色渗出物，但渗出性病变中的视网膜血管炎轻微。尽管全身应用阿昔洛韦，白色渗出物仍从周边向视网膜后极部融合进展，并在10周内累及黄斑。在左眼观察到病变8周后，右眼发现了相同的病变。白色渗出性病变消失后，视网膜萎缩，视网膜血管变窄，但未观察到视网膜脱离。最近，福斯特及其同事将快速进展性外层视网膜坏死描述为艾滋病患者水痘带状疱疹病毒视网膜炎的一种新实体。我们认为我们的病例与快速进展性外层视网膜坏死非常相似。该病例表明，对于患有水痘带状疱疹性皮炎的艾滋病患者，我们必须仔细随访快速进展性外层视网膜坏死。
