Macular dual retinitis with Herpes simplex and Cytomegalovirus following periocular corticosteroid in a patient of Pemphigus Vulgaris

Acute Retinal Necrosis Caused by Varicella Zoster Virus and Cytomegalovirus Co-Infection

PURPOSE

To report the clinical course of two cases of acute retinal necrosis (ARN) caused by varicella zoster virus (VZV) and cytomegalovirus (CMV) co-infection detected by polymerase chain reaction (PCR) on aqueous tap.

METHODS

Observational case reports.

RESULTS

Two patients presented to our services with unilateral panuveitis suggestive of ARN complicated by hemorrhagic vasculitis and started empirical therapy. Aqueous PCR was performed on the same day and showed double positivity for VZV and CMV, which guided treatment. At follow-up, wide-field color fundus imaging and high-resolution optical coherence tomography showed resolution of active retinitis.

CONCLUSION

Our cases suggest that ARN complicated by hemorrhagic vasculitis may be secondary to CMV and VZV co-infection, both in patients with an unremarkable clinical history and in those with immunodeficiency. In our cases, aqueous PCR testing was of paramount importance to determine the aetiology of ARN and to adjust the antiviral therapy accordingly.

Focal Posterior Herpetic Retinitis

Despite having 20/20 vision, a 17-year-old Emirati female presented with central visual changes in her left eye. These changes were attributed to a dull foveal reflex with pigmentary alterations. Retinal pigment epithelium (RPE) mottling at the macula level, attenuating the ellipsoid zone, and a hyper-reflective line connecting the RPE to the outer nuclear layer was observed through spectral domain optical coherence tomography (SD-OCT) of the left eye. In the presence of negative results from laboratory evaluations, the patient was started on oral prednisolone. The medication induced an increased reflectivity of the inner layers on SD-OCT, which turned into a full-thickness macular retinitis with vitreous inflammation, causing a visual decrease to 20/80. A vitreous tap confirmed a positive result for HSV-1, and the patient was prescribed oral valacyclovir 3 g. This treatment led to a resolution of the retinitis and a restoration of the patient's vision to 20/25.

Retinitis after haematopoietic stem cell transplantation with multiple intraocular viral infections (cytomegalovirus, Epstein‒Barr virus and herpes simplex virus)- a case report

BACKGROUND

To report a case of retinitis with multiple intraocular viral infections after second haematopoietic stem cell transplantation.

CASE PRESENTATION

A 39-year-old female patient developed retinitis after a second haematopoietic stem cell transplant. Right eye was tested for three viral infections- cytomegalovirus, Epstein‒Barr virus and herpes simplex virus, while left was infected with cytomegalovirus. The patient was subsequently treated with vitreous cavity ganciclovir injections, and 1 week later both eyes tested negative for aqueous humour viruses.

DISCUSSION AND CONCLUSION

CMV, EBV and HSV belong to the herpes virus family. They are all commonly observed in the body and represent opportunity infectious viruses. The retinitis they cause have different characteristics. But simultaneous infection of the eye by multiple viruses is quite rare. In this case, three viruses were detected in the patient's eye, but whether the retina was caused by all three viruses at the same time could not be determined. A satisfactory outcome was achieved after treatment with vitreous cavity ganciclovir injection.