Abstract Details

Title A Case of Bilateral Acute Retinal Necrosis and Optic Neuritis Secondary to HSV-2 Infection

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) Neuro-ophthalmology/Neuro-otology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 016

Background Herpes simplex virus (HSV) type 2 is a rare cause of acute retinal necrosis (ARN) and optic neuritis, characterized by progressive retinal and optic nerve damage, inflammation of the eye, and poor prognosis of visual recovery. We present a case of bilateral ARN and optic neuritis secondary to HSV-2 infection with a small area of asymptomatic thoracic transverse myelitis.

Objective NA

Design/Methods An 83-year-old woman with type 2 diabetes mellitus with peripheral neuropathy, atrial fibrillation, and end-stage renal disease developed acute progressive nonpainful vision loss for 5 days, worse on the left. She had a fever of 38.1 C but apart from visual deficits and mild neuropathy, neurological examination was unremarkable. Ophthalmological examination revealed disc edema, diffuse macular whitening and hemorrhages, and attenuated vessels with sheathing and sclerosis consistent with retinal vasculitis, retinal necrosis, and optic neuritis. ESR was elevated at 91 but C-reactive protein was normal. MRI brain and orbits showed enhancement of the left optic nerve sheath, optic nerve, and orbital wall, and MRI cervical and thoracic spinal cord revealed T10-T11 level cord enhancement. CSF revealed normal glucose, protein of 125 mg/dL, white blood cell count of 126/mm³ with a lymphocyte predominance, and film array panel positive for HSV-2. She was started on renally-dosed acyclovir for 2 weeks, then transitioned to oral acyclovir. At follow-up 4 weeks later, she had no improvement in her vision but no worsening or recurrent symptoms.

Results NA

Conclusions HSV-2 infection most often presents neurologically in adults as aseptic meningitis but can involve multiple different parts of the nervous system. MRI and CSF studies should be considered when patients develop ARN. Early diagnosis and treatment with antivirals is crucial to prevent further damage and complications.

Authors/Disclosures
Busranur Agac, MD PRESENTER	Dr. Agac has nothing to disclose.
Kanika Sharma, MD (Rutgers- RWJMS)	Dr. Sharma has nothing to disclose.
Christine Gill, MD (University of Iowa Hospitals and Clinics, Department of Neurology)	Dr. Gill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics . Dr. Gill has received personal compensation in the range of $500-$4,999 for serving as a Contributing Author with Continuum .
Tracey Cho, MD, FAAN	Dr. Cho has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of an immediate family member of Dr. Cho has received research support from NIH. Dr. Cho has received publishing royalties from a publication relating to health care.