acyclovir and Ischemia

X-linked lymphoproliferative disorder typically presents as an Epstein-Barr virus-specific immune defect with a poor prognosis. Herein we present the clinical and pathologic findings for the first known case of X-linked lymphoproliferative disorder with visual symptoms at initial presentation.. Retrospective chart review, clinicopathologic correlation (brain biopsy and postmortem brain and eye tissue), and literature review.. An 18-year-old boy had a unique presentation of X-linked lymphoproliferative disorder with visual symptoms and retinal findings. He subsequently developed central nervous system vasculitis. He never had evidence of Epstein-Barr virus infection during his clinical course, but in situ hybridization was positive in scattered cells in the brain postmortem. Eye pathologic examination at autopsy showed ischemic changes, but no inflammation.. When a young patient presents with cotton wool spots, a thorough workup must be done, and immunologic disorders should be considered in the differential diagnosis. X-linked lymphoproliferative disorder-associated eye findings may not always be associated with Epstein-Barr virus infection and, as demonstrated by this case, can be indicative of an underlying vasculitic process.

Topics: Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Epstein-Barr Virus Infections; Fatal Outcome; Herpesvirus 4, Human; Humans; In Situ Hybridization; Ischemia; Lymphoproliferative Disorders; Male; Meningococcal Vaccines; Real-Time Polymerase Chain Reaction; Retinal Diseases; Retinal Vessels; Retrospective Studies; Skin Diseases, Viral; Vasculitis, Central Nervous System

A healthy 56-year-old man developed left-sided herpes zoster ophthalmicus, accompanied initially by ipsilateral anterior uveitis and increased intraocular pressure. Although he was treated in the subacute phase (5 days after skin eruption) with adequate oral doses of acyclovir for 10 days, the condition was later complicated by a left sectorial anterior ischemic optic neuropathy. The pathogenesis of this rare complication is discussed in this article.

Topics: Acyclovir; Fluorescein Angiography; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Ischemia; Male; Middle Aged; Optic Nerve; Papilledema; Prednisone; Visual Fields