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[Bilateral neuroretinitis with zoster infection]
1Abteilungen I (Allgemeine Augenheilkunde mit Poliklinik), Augenklinik der Eberhard-Karls-Universität Tübingen.
Klinische Monatsblatter Fur Augenheilkunde
|April 30, 1999
Summary
Varicella zoster virus infection can cause severe vision loss by affecting the optic nerve and retina. Prompt treatment with steroids and antiviral medication led to significant visual recovery in a patient with rheumatoid arthritis.
Area of Science:
- Ophthalmology
- Neuroscience
- Virology
Background:
- Varicella zoster virus (VZV) infections can affect the optic nerve and retina.
- Pathomechanisms of VZV ocular involvement are debated.
- This case highlights an autoimmune inflammatory reaction as a potential mechanism.
Observation:
- A 69-year-old female presented with sudden, severe bilateral vision loss.
- Funduscopy revealed optic disc edema, retinal hemorrhages, and macular edema in both eyes.
- The patient had a history of rheumatoid arthritis treated with chronic corticosteroids.
Findings:
- Initial treatment with high-dose steroids improved visual acuity.
- Serological tests confirmed active VZV infection.
- Concurrent antiviral therapy (valaciclovir) and gradual steroid reduction led to complete visual recovery and resolution of ocular findings within 2 months.
Implications:
- VZV reactivation, potentially triggered by chronic steroid therapy, can cause severe neuroretinitis.
- The rapid improvement with steroids and antivirals suggests an autoimmune inflammatory process rather than ischemia.
- This case underscores the importance of considering VZV in patients with optic nerve and retinal inflammation, especially those on immunosuppressive therapy.