valacyclovir and Panuveitis

To report a case of herpes simplex virus-induced herpetic necrotizing retinitis after placement of a flucinolone acetonide (Retisert) intravitreal implant.. Interventional case report.. Retrospective chart review.. A 22-year-old male with idiopathic unilateral panuveitis since 2002 that was intolerant of systemic immunosuppressive therapy received a flucinolone acetonide implant 6 years later. Intraocular inflammation was completely quiescent until 1 year following the implant, when he developed retinitis. To the authors' knowledge, this is the first reported case of polymerase chain reaction-proven herpetic necrotizing retinitis following implantation of a Retisert device.. Although rare, herpetic necrotizing retinitis can occur in the setting of local ocular immunosuppression with the Retisert intravitreal implant. This potential infection should be considered in the face of recurrent uveitis following Retisert implantation.

Topics: Acyclovir; Antiviral Agents; Azathioprine; Cataract; Drug Implants; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunosuppressive Agents; Male; Mycophenolic Acid; Panuveitis; Pregnadienetriols; Retinal Necrosis Syndrome, Acute; Treatment Outcome; Valacyclovir; Valine; Visual Acuity; Young Adult

To report the case of an immunocompetent child with herpes simplex virus-2 (HSV-2) acute retinal necrosis (ARN) syndrome, who was considered to have an idiopathic unilateral panuveitis sensitive to steroid treatment.. Polymerase chain reaction for detection of viral DNA was applied to ocular fluids and in situ hybridization was performed on a retinal sample. HSV serology was performed using the ELISA and Western blot techniques, and an in-house indirect immunofluorescence technique.. In addition to the atypical clinical presentation, the serological assays for HSV were negative using ELISA at the time of diagnosis of ARN and 1 year after. HSV2 infection was confirmed by using polymerase chain reaction of aqueous humor specimen and in situ hybridization of a retinal biopsy. Retrospective analysis with the Western blot technique detected low titers of anti-HSV antibodies, when the sera were concentrated 5-fold.. Herpes virus infections must be investigated in children with posterior or panuveitis. PCR analysis is a reliable technique for diagnosis. This case emphasizes that clinical presentation can be atypical and that a negative viral serology does not exclude an acute or a past herpetic infection.

Topics: Acyclovir; Antibodies, Viral; Antiviral Agents; Aqueous Humor; Child, Preschool; Chronic Disease; DNA, Viral; Enzyme-Linked Immunosorbent Assay; Eye Infections, Viral; Herpes Simplex; Herpesvirus 2, Human; Humans; In Situ Hybridization; Male; Panuveitis; Polymerase Chain Reaction; Retinal Necrosis Syndrome, Acute; Valacyclovir; Valine