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Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency
M Kashiwase1, T Sata, Y Yamauchi
1Department of Ophthalmology, Tokyo Medical University, Japan.
Objective/Background:
To identify the etiologic agent of rapidly progressive outer retinal necrosis (PORN) in a 32-year-old man with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. Death occurred after failure of multiple organs.
Design:
Case report.
Methods:
Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions.
Main Outcome Measure:
Immunohistochemistry.
Results:
All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the damaged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the periphery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina.
Conclusions:
PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, HSV-1 can be an etiologic agent.
Insights
Herpes simplex virus type 1 (HSV-1) was identified as a cause of rapidly progressive outer retinal necrosis (PORN) in an AIDS patient, challenging previous assumptions about varicella-zoster virus (VZV). This finding expands the understanding of viral retinitis in immunocompromised individuals.
Area of Science:
- Ophthalmology
- Virology
- Immunology
Background:
- Rapidly progressive outer retinal necrosis (PORN) is a severe form of retinitis often seen in patients with acquired immunodeficiency syndrome (AIDS).
- Cytomegalovirus (CMV) retinitis is common in AIDS patients, but PORN has been historically attributed to varicella-zoster virus (VZV).
Observation:
- A 32-year-old man with AIDS presented with clinical signs of PORN, characterized by multiple yellowish spots in the deep retina without significant intraocular inflammation.
- Despite initial retinitis attributed to CMV, the patient experienced multiple organ failure and death.
Findings:
- Autopsy examination of the globes revealed severe retinal damage with focal calcification and cytomegalic inclusion bodies consistent with CMV.
- Immunohistochemistry identified cytomegalovirus (CMV) antigens in the posterior retina and, crucially, herpes simplex virus type 1 (HSV-1) antigens in the periphery of both retinas.
- No VZV antigens were detected, indicating HSV-1 as a potential etiologic agent in this case.
Implications:
- This case report suggests that herpes simplex virus type 1 (HSV-1) can be an etiologic agent of PORN, particularly in immunocompromised individuals like those with AIDS.
- The findings broaden the spectrum of viral pathogens responsible for necrotizing herpetic retinopathy and necessitate consideration of HSV-1 in the differential diagnosis of PORN.
- Understanding the diverse viral causes of PORN is critical for timely diagnosis and management of vision-threatening conditions in AIDS patients.