Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis
Purpose: To present a rare case of uveo-meningeal syndrome secondary to herpes simplex virus (HSV-1) in a patient with acute retinal necrosis. Observations: A 49-year-old female with a past medical history of herpes simplex encephalitis 18 years prior presented with a 3-day history of right sided he...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-03-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993622001554 |
| _version_ | 1818973427234504704 |
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| author | Megan Haghnegahdar Dante Pennipede Brenton Massey Mary Champion Radwan Ajlan |
| author_facet | Megan Haghnegahdar Dante Pennipede Brenton Massey Mary Champion Radwan Ajlan |
| author_sort | Megan Haghnegahdar |
| collection | DOAJ |
| description | Purpose: To present a rare case of uveo-meningeal syndrome secondary to herpes simplex virus (HSV-1) in a patient with acute retinal necrosis. Observations: A 49-year-old female with a past medical history of herpes simplex encephalitis 18 years prior presented with a 3-day history of right sided headache and decreased vision of the right eye. Her visual acuity was 20/30 in the right eye and 20/20 in the left eye. Clinical examination revealed right relative afferent pupillary defect, panuveitis, and retinal necrosis. Examination of the left eye was unremarkable. Cerebral spinal fluid (CSF) analysis by polymerase chain reaction (PCR) was negative for herpes simplex virus 1 (HSV-1) but did reveal pleocytosis consistent with meningitis. The patient was admitted and empirically treated with intravenous acyclovir (10 mg/kg every 8 hours) and systemic steroids. Topical steroids and cycloplegia were also started. Magnetic resonance imaging revealed no leptomeningeal, pachymeningeal, or parenchymal enhancement. Systemic autoimmune and infectious workup were unremarkable. Based on clinical exam findings and negative PCR results, an anterior chamber tap was performed with aqueous fluid PCR testing which revealed 71,000 copies of HSV-1. A repeat lumbar puncture was performed on day three of admission and revealed a decrease in pleocytosis after initiation of acyclovir therapy and remained negative for HSV on PCR testing. She was discharged home on intravenous acyclovir, topical steroids, and topical cycloplegics. Her retinal necrotic lesions continued to regress and her headaches continued to improve. Conclusions and importance: Uveo-meningeal syndromes are a rare clinical entity that involve the uvea, retina, and meninges. This case highlights the importance of aqueous fluid PCR testing despite negative CSF PCR, as it may hasten treatment with antiviral therapies to preserve vision and limit neurologic sequelae. |
| first_indexed | 2024-12-20T15:23:59Z |
| format | Article |
| id | doaj.art-e6b7ce682a27478f997fcfd14c1197ad |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-12-20T15:23:59Z |
| publishDate | 2022-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-e6b7ce682a27478f997fcfd14c1197ad2022-12-21T19:35:55ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362022-03-0125101409Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosisMegan Haghnegahdar0Dante Pennipede1Brenton Massey2Mary Champion3Radwan Ajlan4Department of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS, 66208, USADepartment of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS, 66208, USADepartment of Neurology, University of Kansas School of Medicine, 3901 Rainbow Boulevard, Mailstop 2012, Kansas City, KS, 66160, USADepartment of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS, 66208, USADepartment of Ophthalmology, University of Kansas School of Medicine, 7400 State Line Road, Prairie Village, KS, 66208, USA; Corresponding author. KU Eye, 7400 State Line Road, Prairie Village, KS 66208, USA.Purpose: To present a rare case of uveo-meningeal syndrome secondary to herpes simplex virus (HSV-1) in a patient with acute retinal necrosis. Observations: A 49-year-old female with a past medical history of herpes simplex encephalitis 18 years prior presented with a 3-day history of right sided headache and decreased vision of the right eye. Her visual acuity was 20/30 in the right eye and 20/20 in the left eye. Clinical examination revealed right relative afferent pupillary defect, panuveitis, and retinal necrosis. Examination of the left eye was unremarkable. Cerebral spinal fluid (CSF) analysis by polymerase chain reaction (PCR) was negative for herpes simplex virus 1 (HSV-1) but did reveal pleocytosis consistent with meningitis. The patient was admitted and empirically treated with intravenous acyclovir (10 mg/kg every 8 hours) and systemic steroids. Topical steroids and cycloplegia were also started. Magnetic resonance imaging revealed no leptomeningeal, pachymeningeal, or parenchymal enhancement. Systemic autoimmune and infectious workup were unremarkable. Based on clinical exam findings and negative PCR results, an anterior chamber tap was performed with aqueous fluid PCR testing which revealed 71,000 copies of HSV-1. A repeat lumbar puncture was performed on day three of admission and revealed a decrease in pleocytosis after initiation of acyclovir therapy and remained negative for HSV on PCR testing. She was discharged home on intravenous acyclovir, topical steroids, and topical cycloplegics. Her retinal necrotic lesions continued to regress and her headaches continued to improve. Conclusions and importance: Uveo-meningeal syndromes are a rare clinical entity that involve the uvea, retina, and meninges. This case highlights the importance of aqueous fluid PCR testing despite negative CSF PCR, as it may hasten treatment with antiviral therapies to preserve vision and limit neurologic sequelae.http://www.sciencedirect.com/science/article/pii/S2451993622001554Uveo-meningeal syndromeAcute retinal necrosisHerpes simplex virus |
| spellingShingle | Megan Haghnegahdar Dante Pennipede Brenton Massey Mary Champion Radwan Ajlan Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis American Journal of Ophthalmology Case Reports Uveo-meningeal syndrome Acute retinal necrosis Herpes simplex virus |
| title | Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis |
| title_full | Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis |
| title_fullStr | Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis |
| title_full_unstemmed | Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis |
| title_short | Uveo-meningeal syndrome secondary to Herpes Simplex Virus related acute retinal necrosis |
| title_sort | uveo meningeal syndrome secondary to herpes simplex virus related acute retinal necrosis |
| topic | Uveo-meningeal syndrome Acute retinal necrosis Herpes simplex virus |
| url | http://www.sciencedirect.com/science/article/pii/S2451993622001554 |
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