sorivudine and Herpes-Zoster-Ophthalmicus

To characterize further a chronic epithelial keratitis caused by varicella-zoster virus infection in patients with acquired immunodeficiency syndrome (AIDS).. Patients with AIDS and chronic epithelial keratitis associated with varicella-zoster virus from 3 institutions were identified. Patient records were reviewed retrospectively for the following data: medical and demographic characteristics, techniques of diagnosis, physical findings, course, response to treatment, and outcome.. Sixteen patients were studied. CD4+ T-lymphocyte cell counts were available in 11 patients, with a median of 0.034 x 10(9)/L (range, 0-0.094 x 10(9)/L). Two patients had no history of a zosteriform rash. In the remaining patients, the interval between rash and keratitis ranged from 0 days to 6 years. In all cases, the keratitis was chronic and characterized by gray, elevated, dendriform epithelial lesions that stained variably with fluorescein and rose bengal. The peripheral and midperipheral cornea was most commonly affected, and, in 13 of the 16 patients, the lesions crossed the limbus. Pain was a prominent feature, occurring in 12 of 16 patients. In 9 of 12 patients tested, varicella-zoster virus was identified by culture, direct fluorescent antibody testing, polymerase chain reaction testing, or a combination of these studies, with direct fluorescent antibody testing (6 of 8 positive results) and polymerase chain reaction testing (3 of 3 positive results) appearing to be the most sensitive. Response to antiviral medication was variable.. In patients with AIDS, varicella-zoster virus may cause a chronic infection of the corneal epithelium. The keratitis is characterized by dendriform lesions, prolonged course, and frequently by extreme pain. It can occur without an associated dermatitis.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Aged; Antiviral Agents; Arabinofuranosyluracil; CD4 Lymphocyte Count; Chronic Disease; Epithelium, Corneal; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Keratitis, Dendritic; Male; Middle Aged; Retrospective Studies

We report on the case of a 23-year-old female who presented with ocular signs of progressive outer retinal necrosis (PORN) syndrome and who failed to respond to acyclovir, ganciclovir, foscarnet and oral sorivudine.. The patient was treated with the antiviral drugs acyclovir, ganciclovir, foscarnet and oral sorivudine.. The patient failed to respond to a combination of antiviral drugs. Unfortunately, progression of the retintis occurred, which led to blindness.. Despite new drugs, the prognosis of PORN is poor and recurrence is common.

Topics: Adult; AIDS-Related Opportunistic Infections; Antibodies, Viral; Antiviral Agents; Arabinofuranosyluracil; Blindness; DNA, Viral; Drug Therapy, Combination; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Herpesvirus 3, Human; Humans; Recurrence; Retinal Necrosis Syndrome, Acute; Treatment Failure

We examined a patient with progressive outer retinal necrosis, which is presumably caused by the varicella-zoster virus in patients with the acquired immunodeficiency syndrome.. The patient was successfully treated with a combination of intravitreal ganciclovir and oral sorivudine. Treatment for progressive outer retinal necrosis has been disappointing; both acyclovir and ganciclovir have had only limited success. Sorivudine, a new antiviral medication with activity against varicella-zoster virus, may represent an effective alternative treatment for retinal necrosis.

Topics: AIDS-Related Opportunistic Infections; Antiviral Agents; Arabinofuranosyluracil; Drug Therapy, Combination; Ganciclovir; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Retinal Necrosis Syndrome, Acute