acyclovir and Optic-Neuritis

Progressive outer retinal necrosis is a necrotizing herpetic retinopathy usually seen in immunocompromised patients. The authors describe two patients with this disease who initially had findings suggestive of an optic neuropathy. Vision declined after treatment with methylprednisolone, after which fundus examination became consistent with progressive outer retinal necrosis. These cases underscore the importance of careful examination of the retinal periphery before management of any presumed optic neuropathy with steroids.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cytomegalovirus Infections; Cytomegalovirus Retinitis; Diagnostic Errors; Diplopia; Disease Progression; Encephalitis, Viral; Female; Foscarnet; Herpes Zoster; Humans; Magnetic Resonance Imaging; Methylprednisolone; Middle Aged; Necrosis; Optic Neuritis; Paresis; Prednisone; Retina

Herpes zoster ophthalmicus (HZO) is an inflammation related to reactivation of the latent varicella zoster virus (VZV), involving the ophthalmic branch of the trigeminal nerve. Optic neuritis (ON), a rare ocular complication following HZO, has been reported in 1.9% of HZO-affected eyes. Most previous cases occurred simultaneously with other ocular complications, especially orbital apex syndrome. Moreover, detailed magnetic resonance imaging (MRI) with diffusion weighted imaging of the optic nerve and trigeminal nucleus in HZO-related ON has been rarely reported. We report a case of postherpetic isolated ON with a concurrent abnormal trigeminal nucleus on imaging.. A healthy 58-year-old female presented with sudden painful visual loss in her right eye for 2 days. Four weeks before the presentation, her right eye was diagnosed with HZO, and she received intravenous acyclovir for 10 days. Ophthalmic examination revealed a visual acuity of light perception and 20/20 in the right and left eyes, respectively. A relative afferent pupillary defect was present in the right eye. Neurological examination was significant for hypoesthesia in the area of the HZO. A clinical diagnosis of HZO-related right retrobulbar ON was made, and other causes of atypical ON were excluded. MRI showed enhancement and restricted diffusion of the right-sided optic nerve with linear hyperintense T2 of the right-sided spinal trigeminal nucleus and tract (STNT) along the brainstem. She received 14 days of intravenous acyclovir and 5 days of methylprednisolone. Both were switched to an oral route for 2 months. After the completion of treatment, the visual acuity was counting fingers and 20/20 in the right eye and left eye, respectively. Stable brainstem STNT abnormalities and resolution of ON were found radiologically.. Isolated ON is a rare ocular complication following HZO. An abnormal high signal of STNT on a T2 weighted image may be present, which may be a clue for VZV-associated complications, such as HZO-related ON, especially in cases lacking an obvious history of HZO or other concomitant ocular complications. Prompt treatment with both acyclovir and corticosteroids should be started. Restricted diffusion of the optic nerve may be a predictor for poor visual recovery.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Middle Aged; Optic Nerve; Optic Neuritis; Trigeminal Nuclei

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Child; Dexamethasone; Encephalitis, Viral; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Magnetic Resonance Imaging; Optic Neuritis

We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis.. Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected. Subjective and objective symptoms could be improved by immediate intravenous administration of antibiotics; however, 1 day before discharge the patient complained of a sudden left-sided, painful loss of vision with extreme photophobia. The ophthalmoscopic examination revealed profound ciliary injection with slight anterior uveitis and papilledema with macular infiltration and diffuse petechiae-like retinal hemorrhage. After exclusion of viral proliferation in the CSF systemic steroid therapy was carried out together with continuation of antibiotic therapy and the eye was treated with local steroids and mydriatics. This resulted in healing of the ocular inflammation and partial recovery of vision.. The painful loss of vision in this patient is probably due to parainfectious optic neuritis with macular infiltrate from Neisseria meningitidis B meningitis, which is an unusual course. Despite the rarity of this disease the complication of a parainfectious inflammation of the optic nerve should be considered and appropriate steps taken when the corresponding symptoms occur.

Topics: Acyclovir; Adrenal Cortex Hormones; Ceftriaxone; Female; Humans; Infusions, Intravenous; Macula Lutea; Meningitis, Meningococcal; Mydriatics; Neisseria meningitidis, Serogroup B; Ophthalmic Solutions; Ophthalmoscopy; Optic Neuritis; Papilledema; Retinal Diseases; Uveitis, Anterior; Young Adult

Retrobulbar neuritis in Herpes Zoster Ophthalmicus (HZO) has been reported very rarely.. To report a very rare case of HZO with retrobulbar neuritis with detailed clinical features and treatment responses.. A fifty-eight- year old male presented with Herpes zoster-retrobulbarneuritis in the left eye. It was characterized by decreased visual acuity, mid dilated pupil with sluggish reaction, normal optic disc and central scotoma in Humphrey visual field. Visual acuity improved with systemic Acyclovir and steroids.. This is a rare case of HZO associated with retrobulbar neuritis. Prompt treatment with systemic antiviral and steroid improve the visual outcome.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Middle Aged; Optic Neuritis

Herpes zoster (HZ) is an acute infection caused by reactivation of the latent varicella-zoster virus [1]. Herpes zoster ophthalmicus (HZO) occurs when inflammation spreads from the ganglion of Gasser to the ophthalmic branch of the trigeminal nerve. Optic neuritis, a very rare sequela of HZO [2-4], can occur simultaneously to the acute vesicular skin eruption or, more frequently, as a postherpetic complication. We report on a 74-year-old woman who presented with HZ optic neuritis 45 days after developing an incompletely treated bout of trigeminal HZ, characterized only by pruritus. It is important to value the non-specific manifestations of cutaneous HZ in the prodromal phase, so as to offer timely and appropriate treatment.

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Evoked Potentials, Visual; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Optic Nerve; Optic Neuritis; Visual Acuity

Here we report a case of optic neuritis in the setting of herpes zoster ophthalmicus (HZO) in a child. A six-year-old girl presented with HZO in the right eye. During the hospitalization, her visual acuity decreased. Fluorescein angiography (FAG) and optical coherence tomography revealed optic neuritis in the affected eye. Visual acuity improved with one month of treatment with acyclovir and steroids. FAG analysis showed no evidence of leakage at the optic disc. At one year post treatment, the patient's fundus exam and vision were normal. Therapy with antivirals and steroids may be effective in patients with childhood HZO optic neuritis.

Topics: Acyclovir; Child; Drug Therapy, Combination; Female; Fluorescein Angiography; Herpes Zoster Ophthalmicus; Humans; Optic Neuritis; Steroids; Visual Acuity

We report here the case of a three-year-old boy presenting with an optic neuritis during the invasive phase of a chicken pox. This clinical, infrequent picture, can be directly due to the virus or be secondary to an auto-immune mechanism. The examination of the ocular fundus, the profile of the spinal fluid, the MRI and the measure of visual evoked potential allow to reach diagnosis and to identify the type of lesion. There is no consensus on the treatment of this optic neuritis and the current attitude is therapeutic abstention because of a rapid spontaneous improvement. Cerebellitis, meningitis can also be seen during chicken pox. Their evolution is quickly favorable, not requiring additional exam. Encephalitis can result from an auto-immune lesion of the white matter and require then the use of corticoids with antiviral drugs.

Topics: Acyclovir; Antiviral Agents; Ataxia; Chickenpox; Child, Preschool; Electroencephalography; Encephalitis, Viral; Evoked Potentials, Visual; Follow-Up Studies; Fundus Oculi; Humans; Magnetic Resonance Imaging; Male; Myoclonus; Optic Neuritis; Prognosis; Time Factors

To report two cases of progressive outer retinal necrosis occurring in immunocompetent individuals after treatment with corticosteroids for presumed optic neuropathy.. Observational case report.. University-based tertiary eye hospital.. Retrospective review of existing clinical records.. Two patients were treated empirically with systemic corticosteroids for suspected inflammatory papillopathy. Subsequently, both were diagnosed with necrotizing herpetic retinitis with features of progressive outer retinal necrosis. Anterior chamber paracentesis confirmed varicella-zoster infection. Both patients were human immunodeficiency virus negative; one patient with rheumatoid arthritis was taking etanercept. Both became completely blind in one eye despite intensive treatment with antiviral medication intravenously and intravitreally.. Progressive outer retinal necrosis is not confined to patients with underlying severe immunodeficiency, such as acquired immune deficiency syndrome. Initial treatment of acute, unexplained vision loss with systemic corticosteroids may lead to catastrophic visual loss in patients with evolving necrotizing herpetic retinopathy.

Topics: Acyclovir; Aged; Antiviral Agents; Aqueous Humor; Blindness; DNA, Viral; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; Glucocorticoids; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Immunocompromised Host; Middle Aged; Multiple Sclerosis; Optic Neuritis; Polymerase Chain Reaction; Prednisone; Pupil Disorders; Retinal Necrosis Syndrome, Acute; Retrospective Studies

To present a unique case in which orbital inflammation, proptosis, and optic neuritis were the initial symptoms of acute retinal necrosis (ARN). The clinical presentation of ARN, as well as the currently recommended diagnostic procedures and guidelines for medical treatment of ARN, are summarized.. Interventional case report.. Polymerase chain reaction (PCR) techniques were made on the vitreous for cytomegalovirus, Epstein-Barr virus, herpes simplex virus (HSV), varicella zoster virus, and toxoplasmosis. A full laboratory evaluation was made together with HLA-typing and serologic tests measuring convalescent titers for HSV and other micro-organisms. Magnetic resonance imaging scan, computed tomography (CT) scan, and fluorescein angiographic examination were performed. The patient was treated with acyclovir and oral prednisone.. The patient was evaluated for initial and final visual acuity and for degree of proptosis, periocular edema, and vitreitis.. The first symptoms and signs of ARN were eye pain, headache, proptosis, and a swollen optic nerve on CT scan. Other than increased C-reactive protein, all blood samples were normal. PCR was positive for HSV-type I in two separate vitreous biopsies. The patient had the strongly ARN-related specificity HLA-DQ7.. This is the first report of HSV-induced ARN presenting with inflammatory orbitopathy and optic neuritis. Polymerase chain reaction for HSV-1 was positive more than 4 weeks after debut of symptoms, which is a new finding. The combination of severe vitreitis and retinal whitening, with or without proptosis, should alert the clinician to the possibility of herpes infection and treatment with intravenous acyclovir started promptly.

Topics: Acyclovir; Adult; Antibodies, Viral; DNA, Viral; Exophthalmos; Eye Infections, Viral; Female; Fluorescein Angiography; Herpes Simplex; Herpesvirus 1, Human; Humans; Magnetic Resonance Imaging; Optic Neuritis; Orbital Pseudotumor; Polymerase Chain Reaction; Prednisolone; Retinal Necrosis Syndrome, Acute; Tomography, X-Ray Computed; Vitreous Body

This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome.. Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection.. Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery.. Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Cerebrospinal Fluid; Female; Foscarnet; Fundus Oculi; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Meningitis, Viral; Optic Neuritis; Orbital Diseases; Retinitis; Skin Diseases, Viral; Visual Acuity

We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The neuritis responded well to treatment with foscarnet, but, 3 weeks into therapy, varicella zoster retinitis developed. Additional treatment with intravenous acyclovir stopped progression of the retinitis and resulted in healing of the retinal lesions. This case suggests that retrobulbar optic neuritis can be regarded as a prodrome of imminent acute retinal necrosis. Early recognition and prompt therapy with combined antivirals may prevent the development of this devastating ocular complication of varicella zoster infection.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; AIDS-Related Opportunistic Infections; Antiviral Agents; Female; Foscarnet; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Male; Optic Neuritis; Visual Acuity

To report a case of acute viral disease accompanied by bilateral optic neuritis with substantial paraclinical evidence that human immunodeficiency virus was the causative agent.. Clinical and paraclinical examination. Magnetic resonance imaging.. Virus and antibody titers as well as reverse lymphocytosis were consistent with acute infection by the human immunodeficiency virus-1.. Human immunodeficiency virus infection should be considered in the differential diagnosis of acute optic neuritis.

Topics: Acute Disease; Acyclovir; Adult; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Female; HIV Antibodies; HIV Infections; HIV-1; Humans; Magnetic Resonance Imaging; Optic Nerve; Optic Neuritis; Polymerase Chain Reaction; Prednisolone; RNA, Viral

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Optic Neuritis; Prednisolone; Retinitis

Topics: Acyclovir; Aged; Dexamethasone; Drug Therapy, Combination; Herpes Zoster Ophthalmicus; Humans; Male; Optic Neuritis; Papilledema; Visual Acuity

This paper reports on the physical and chemical characteristics of agents isolated from serum samples of patients presenting with epidemic neuropathy. The behaviour of isolated enteroviruses was as described for such viruses. Mild cytopathogenic effects-producing agents behaved in a variable form regarding sensitivity to chloroform; on the other hand they were neither sensitive to phosphonoacetic acid (PAA) nor to guanidine hydrochloride (GHC1) and grew in cells previously treated with bromodeoxyuridine (BDUR). These results suggest the presence of agents resembling enteroviruses and enveloped viruses. Further studies for the characterization of such agents need to be performed.

Topics: Acyclovir; Antiviral Agents; Bromodeoxyuridine; Chemical Phenomena; Chemistry, Physical; Cuba; Disease Outbreaks; Enterovirus; Guanidine; Humans; Hydrogen-Ion Concentration; Optic Neuritis; Peripheral Nervous System Diseases; Phosphonoacetic Acid; Temperature

The bilateral simultaneous optic neuritis is rarely associated with multiple sclerosis. Diagnosis and prognosis have to be dealt with independently.. A 45-year-old woman presented with an acute bilateral simultaneous amaurosis which developed within one day with bilateral papilledema. Initially there were positive antinuclear and anticytoplasmatic antibodies and antibodies against heart and skeletal muscles. The serum titer was elevated for immunoglobulin A, lowered for complement factors C3 and C4. Antigens for polio-virus type 3 and coxsackievirus type B5 and B3 were borderline positive. An oncologic, toxic or vascular cause of the neuritis was unlikely.. The amaurosis lasted for 4 days. Vision improved gradually under a combined therapy with steroids, antibiotics and virostatics. Nineteen months later the vision was 20/25 OD and 20/200 OS.. The acute bilateral neuritis was probably of autoimmunological origin. Under combined antiinfectious and steroidal therapy vision improved more than expected.

Topics: Acyclovir; Autoantibodies; Autoimmune Diseases; Blindness; Cardiolipins; Ceftriaxone; Complement C3; Complement C4; Diagnosis, Differential; Drug Therapy, Combination; Female; Fluorescein Angiography; Humans; Immunoglobulin A; Methylprednisolone; Middle Aged; Optic Neuritis; Visual Acuity; Visual Fields

Topics: Acyclovir; Adult; Female; Herpes Zoster Ophthalmicus; HIV Seropositivity; Humans; Injections, Intravenous; Methylprednisolone Hemisuccinate; Optic Neuritis; Tomography, X-Ray Computed

Topics: Acyclovir; Adult; Blindness; Herpes Zoster Ophthalmicus; Humans; Male; Optic Atrophy; Optic Neuritis

Inoue-Melnick virus (IMV) was isolated from the cerebrospinal fluid of patients with chronic neurologic disorders. The effect of acyclovir (ACV), 9-(2-hydroxyethoxymethyl)-guanine, on the growth of IMV was studied in human diploid cell cultures. ACV markedly inhibited the multiplication of all three IMV serotypes in vitro with the same inhibitory effect. By passage of IMV in the presence of ACV in the medium, ACV-resistant mutants of three IMV serotypes were easily isolated.

Topics: Acyclovir; Cell Line; Humans; Multiple Sclerosis; Myelitis; Optic Neuritis; Serotyping; Syndrome; Viruses

Three cases of bilateral optic neuritis, one of which also had transverse myelitis, are described in young adults following chickenpox. Severe bilateral loss of vision developed in all cases and was followed by good visual recovery in the two with isolated optic neuritis, but poor recovery in the patient with concomitant transverse myelitis. The interval between the initial rash and subsequent optic neuritis suggests an immunological pathogenesis for this complication.

Topics: Acyclovir; Adult; Chickenpox; Dexamethasone; Female; Humans; Male; Myelitis, Transverse; Optic Neuritis; Prednisone; Vision Disorders