Herpetic Panophthalmitis: A Diagnostic Dilemma

Area of Science:

• Ophthalmology
• Infectious Diseases
• Virology

Background:

• Ocular infections can present with varied clinical manifestations.
• Herpes simplex virus 2 (HSV-2) is a common cause of mucocutaneous infections, but ocular involvement is less frequent.
• Panophthalmitis is a severe intraocular inflammation with a poor visual prognosis.

Observation:

• A case of a 32-year-old female with no prior herpesvirus history presented with hypertensive granulomatous panophthalmitis and optic neuropathy.
• The condition was initially misdiagnosed as orbital cellulitis.
• Despite antibiotic and steroid treatment, the patient's condition worsened.

Findings:

• Human herpes simplex virus 2 (HSV-2) was identified in the vitreous humor.
• This represents an uncommon presentation of HSV-2 ocular infection.
• The case is discussed alongside other reported instances of herpes simplex and varicella zoster virus-induced panophthalmitis.

Implications:

• Ocular HSV-2 infection should be considered in the differential diagnosis of severe panophthalmitis, even without a history of mucocutaneous lesions.
• Early and accurate diagnosis is crucial for appropriate management of severe ocular infections.
• Understanding rare presentations of viral ocular infections aids in improving diagnostic and therapeutic strategies.