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Varicella Zoster Virus-Induced Acute Retinal Necrosis Following Acute Meningoencephalitis in a Patient With Presumed Covid-19 Publisher



Hassanpour K1 ; Khorasanizadeh F2, 3 ; Nabavi M4 ; Daftarian N1, 5, 6 ; Ramezani A5, 7
Authors
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Authors Affiliations
  1. 1. Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Department of Radiology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Infectious Disease, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Arthritis Research Canada, Vancouver, BC, Canada
  6. 6. Department of Medicine, The University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
  7. 7. Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Journal of Ophthalmic and Vision Research Published:2024


Abstract

Purpose: To report the coincidence of acute retinal necrosis (ARN) syndrome following acute meningoencephalitis and presumed coronavirus disease 2019 (COVID-19) in an immunocompetent patient.Case Report: A 58-year-old female presented to our emergency department with sudden unilateral visual loss following a recent hospitalization for viral meningoencephalitis. Magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcription polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient. Ophthalmic examination revealed severe ocular inflammation and yellowish patches of necrotizing retinitis in the right eye, compatible with the diagnosis of ARN. The result of aqueous humor PCR was positive for varicella zoster virus (VZV). The patient received a single intravitreal ganciclovir injection and 10 days of intravenous ganciclovir, followed by oral acyclovir. The patient underwent COVID-19 screening tests: while the chest CT scan showed features highly suggestive of COVID-19, the RT-PCR was negative on two occasions. Two months later, best-corrected visual acuity improved to 20/70 in the right eye, the anterior chamber reaction and keratic precipitates resolved, and the vitreous haze decreased significantly.Conclusion: A case of VZV-induced ARN following acute meningoencephalitis was observed in association with presumed COVID-19. This could be an incidental finding during the COVID-19 pandemic; however, it could also suggest that COVID-19 might trigger ARN in cases with latent herpes family viruses. © 2024 Hassanpour et al.
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