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Wang P, An M, Zhang M, Yan X, Tong N. Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review. Front Immunol 2024; 15:1301329. [PMID: 38322266 PMCID: PMC10844496 DOI: 10.3389/fimmu.2024.1301329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Acute retinal necrosis (ARN) is an inflammatory disease that is primarily caused by herpesvirus infection, most commonly varicella-zoster virus (VZV), followed by herpes simplex virus (HSV) and occasionally cytomegalovirus (CMV). Sintilimab is an immune checkpoint inhibitor (ICI) that can enhance the body's anti-tumor immune response. However, treatment with ICIs may lead to reactivation of the VZV. Here, we present a case of ARN caused by VZV infection in a patient receiving sintilimab for cervical cancer. A 64-year-old female patient developed vision loss and floaters with left eye redness for one week after 22 cycles of sintilimab for cervical cancer. Based on clinical manifestations, ophthalmological examination, and vitreous humor biopsy, the patient was diagnosed with acute retinal necrosis syndrome secondary to VZV. After receiving systemic antiviral and anti-inflammatory therapy, retinal necrosis lesions and visual function improved. In conclusion, clinicians should be aware of the risk of ARN when using sintilimab and should actively monitor patients for prompt diagnosis and optimal management of this rare adverse drug reaction.
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Affiliation(s)
- Pei Wang
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
- School of Medicine, Qingdao University, Qingdao, Shandong, China
| | - Ming An
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Mengmeng Zhang
- Department of Pathology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Xiaoran Yan
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Nianting Tong
- Department of Ophthalmology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
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Makri OE, Tsekouras IK, Leonidou L, Kagkelaris K, Kozobolis V, Georgakopoulos CD. Kyrieleis Arteriolitis Associated with Acute Retinal Necrosis due to Herpes Simplex Virus Type 1 Secondary to Herpetic Encephalitis. Vision (Basel) 2022; 6:vision6020027. [PMID: 35645381 PMCID: PMC9149933 DOI: 10.3390/vision6020027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/08/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Olga E. Makri
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Iasonas K. Tsekouras
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Leonidia Leonidou
- Internal Medicine, Department of Internal Medicine, Patras University Hospital, 265 04 Patras, Greece;
| | - Konstantinos Kagkelaris
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Vassilios Kozobolis
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
| | - Constantinos D. Georgakopoulos
- Department of Ophthalmology, Medical School, University of Patras, 265 04 Patras, Greece; (O.E.M.); (I.K.T.); (K.K.); (V.K.)
- Correspondence:
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Teitelbaum S, Azevedo LH, Bernaola-Paredes WE. Antimicrobial Photodynamic Therapy Used as First Choice to Treat Herpes Zoster Virus Infection in Younger Patient: A Case Report. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:232-236. [DOI: 10.1089/photob.2019.4725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Susana Teitelbaum
- Department of Onco-Hematological Pediatric, Perez Scremini Foundation, Montevideo, Uruguay
| | - Luciane Hiramatsu Azevedo
- Clinician of Special Laboratory of Laser in Dentistry (LELO), School of Dentistry, University of São Paulo (USP), São Paulo, Brazil
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Lei B, Zhou M, Wang Z, Chang Q, Xu G, Jiang R. Ultra-wide-field fundus imaging of acute retinal necrosis: clinical characteristics and visual significance. Eye (Lond) 2019; 34:864-872. [PMID: 31554945 DOI: 10.1038/s41433-019-0587-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/02/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To investigate the clinical characteristics of acute retinal necrosis (ARN) with ultra-wide-field imaging (UWFI) and analyse their visual significance. METHODS Clinical and UWFI records of patients diagnosed with ARN at a single centre over 2 years were reviewed. RESULTS In 38 eyes of 35 patients, the clinical manifestations of ARN on UWFI included patchy (12 eyes) or fan-shaped necrotic lesions (26 eyes), retinal arterial obliteration (38 eyes), vitritis (38 eyes), retinal venous haemorrhage (19 eyes), and vitreous haemorrhage (6 eyes). Retinal detachment was associated with the number of retinal quadrants involved (β = 2.145, P = 0.005). LogMAR BCVA at last follow-up was associated with logMAR BCVA at presentation (β = 0.473, P = 0.004) and retinal detachment (β = 0.367, P = 0.020). CONCLUSION UWFI is useful for detecting retinal lesions in ARN, especially peripheral lesions or through opaque media, and provides valuable information concerning visual prognosis.
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Affiliation(s)
- Boya Lei
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Min Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Zhujian Wang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Gezhi Xu
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Rui Jiang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. .,Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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