Rapidl y Progressiv e Herpeti c Retina l Necrosis : A Blindin g Diseas e C of Advance dDS

Abstract

Eleven patients with rapidly progressive herpetic retinal necrosis (RPHRN) complicating AIDS were investigated retrospectively to study the disease spectrum, systemic involvement, and therapy. The mean CD4 cell count was 24/microL. There was a characteristic disease pattern with rapid progression, 82% bilaterality, relative resistance to intravenous antiviral therapy, and 70% retinal detachment. Varicella-zoster virus was the probable cause in 10 patients (detected by polymerase chain reaction in two eyes investigated), and herpes simplex virus was the probable cause in one. Cutaneous zoster occurred previously in 73% but was not concurrent. Seventy-three percent had central nervous system disease, possibly virus-related. RPHRN may be a local herpetic recrudescence in an immune-privileged site with transneural spread. Only four of 20 affected eyes retained useful vision. Poor ocular bioavailability, retinal ischemia, acquired drug resistance, and strain pathogenicity may underlie treatment failure. Acyclovir therapy appears relatively ineffective. Combined intravenous and intravitreal therapy with foscarnet and ganciclovir may be the best current management. Research advances are needed urgently.

Varicella zoster virus (VZV)-related progressive outer retinal necrosis (PORN) after allogeneic stem cell transplantation

“…2,3 As such, hematogenous dissemination during herpes zoster eruptions has been suggested as a predisposing factor. 5 It has also been suggested that resistance of VZV to aciclovir may contribute to the pathogenesis of PORN, since the occurrence of aciclovir resistance is known to be relatively common in the course of repeated VZV infections in immunocompromised patients.…”

Diagnóstico y tratamiento de infecciones oportunistas en el paciente adulto con infección por VIH/SIDA

“…La infección por VHZ es habitualmente de fácil manejo pero, en pacientes gravemente inmunosuprimidos (linfocitos T-CD4 < 100 céls/mL), se puede asociar a diseminación al SNC con vasculitis, leucoencefalitis multifocal, ventriculitis, mielitis y mielo-radiculitis, neuritis . La necrosis exterior retiniana progresiva se presenta en este mismo contexto de paciente y debe diferenciarse de la necrosis retiniana aguda por VHS [107][108][109] . La necrosis exterior retiniana progresiva cursa con mí-nima infl amación del humor acuoso y vítreo, ausencia de vasculitis retinal y múltiples lesiones periféricas pequeñas en las capas superfi ciales de retina.…”

Retrobulbar Optic Neuritis and Meningoencephalitis Following Progressive Outer Retinal Necrosis due to CMV in a Patient with AIDS

“…Furthermore, members of the Herpesviridae family could conceivably migrate to other visual structures and the CNS via transneuronal spread from contiguous infected sites [5,6]. Herpetic retrobulbar optic neuritis or viral meningoencephalitis is progressive in untreated patients [7][8][9].…”