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Acute retinal necrosis in a neonate
Christina Hsu1, Nader Moinfar, Brian Lipman
1*University of Central Florida College of Medicine, Orlando, Florida; †Magruder Eye Institute, Orlando, Florida; ‡Winnie Palmer Hospital, Orlando, Florida; and §Associated Retina Consultants, Royal Oak, Michigan.
Retinal Cases & Brief Reports
|November 11, 2014
Summary
A neonate developed acute retinal necrosis due to herpes simplex virus (HSV) type 2, despite no prior history. This case highlights potential HSV transmission from in vitro fertilization donor eggs.
Area of Science:
- Ophthalmology
- Neonatology
- Infectious Diseases
Background:
- Herpes simplex virus (HSV) infection can cause severe neonatal complications.
- Congenital HSV infections are rare but can lead to significant morbidity.
- Acute retinal necrosis (ARN) is a severe intraocular inflammation.
Purpose of the Study:
- To present a unique case of dizygotic twins where one neonate developed HSV type 2-induced acute retinal necrosis.
- To highlight a potential route of congenital HSV transmission via in vitro fertilization (IVF) donor eggs.
Main Methods:
- Retrospective chart review of a single case.
- Clinical examination including funduscopy.
- Laboratory investigations: Polymerase chain reaction (PCR) for HSV-2 and serology.
- Ophthalmic management including laser cerclage and scleral buckle surgery.
Main Results:
- A premature infant born via IVF developed a rash and signs of retinitis, diagnosed as HSV-2 infection.
- PCR confirmed HSV-2 in the anterior chamber fluid; serology was positive for HSV-2 IgG in mother and infant.
- The affected infant underwent laser cerclage for ARN and later surgery for retinal detachment, with residual visual impairment.
- The co-twin remained unaffected.
Conclusions:
- Congenital acute retinal necrosis can occur in neonates, even without a known maternal or fetal history of HSV.
- Transmission of HSV from an IVF donor egg is a plausible, albeit rare, cause of congenital infection.
- Clinicians should consider IVF donor egg transmission in the differential diagnosis of neonatal HSV infections, particularly with atypical presentations.
