Systemic herpetic infection diagnosed by retinal biopsy

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.