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Herpes simplex virus type 1 encephalitis associated with acute retinal necrosis syndrome in an immunocompetent
Philippe Gain1, Christophe Chiquet, Gilles Thuret
1Department of Ophthalmology, Bellevue Hospital, Saint-Etienne, France. philippe.gain@univ-st-etienne.fr
Purpose:
The onset of acute retinal necrosis secondary to herpes simplex encephalitis is exceptional. We report such an association in an immunocompetent patient, in whom the genome of herpes simplex virus type 1 (HSV-1) was identified successively at both sites of infection.
Methods:
Polymerase chain reaction (PCR) assay of HSV-1 in cerebrospinal fluid (CSF) and aqueous humour.
Results:
An immunocompetent patient aged 40 years presented with HSV-1 encephalitis, which was confirmed by imaging, viral serology and identification of the HSV-1 genome in the CSF. The subject's immunological profile was normal. The patient was treated with foscavir. Six weeks after clinical recovery and negative PCR, the patient presented with a unilateral acute retinal necrosis syndrome. Polymerase chain reaction of the aqueous humour was positive, while serology and PCR of the CSF remained negative.
Conclusion:
Identification of the HSV-1 genome at the two successive sites of infection stresses the possibility of brain-to-eye transmission of HSV-1.