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Systemic herpetic infection diagnosed by retinal biopsy
M A Friedberg1, J C Schwartz, M C Feinman
1Washington National Eye Center, DC.
Ophthalmic Surgery
|March 1, 1993
Summary
Systemic lupus erythematosus patients can develop serious neurological and vision issues. Prompt diagnosis and treatment with acyclovir, potentially alongside optic-nerve-sheath decompression, are crucial for recovery.
Area of Science:
- Neuro-immunology
- Ophthalmology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with diverse clinical manifestations.
- Patients with SLE are often immunocompromised due to the disease itself or immunosuppressive therapies.
- Neurological and ocular complications can arise in SLE, posing diagnostic challenges.
Observation:
- A patient with SLE presented with myelopathy, optic neuropathy, retinopathy, and aseptic meningitis.
- Initial treatments with immunosuppressants and antimicrobials were ineffective.
- Cultures and brain biopsy were unrevealing, but retinal biopsy suggested a Herpes virus infection.
Findings:
- Herpes virus infection was suspected based on retinal biopsy findings in an immunocompromised SLE patient.
- Acyclovir therapy led to dramatic clinical improvement.
- Optic-nerve-sheath decompression was also part of the treatment regimen.
Implications:
- This case highlights the potential for opportunistic herpetic infections in iatrogenically suppressed SLE patients.
- It underscores the importance of considering viral etiologies in refractory neurological and ocular symptoms.
- Tissue diagnosis, such as retinal biopsy, is critical for identifying specific pathogens and guiding effective treatment.