First Author: N.Berker TURKEY
Co Author(s): P. Ozdal C. Karahan P. Yilmazbas
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To report a very rare case of an immunocompetent 18 years-old patient with Herpes Simple Virus 1 (HSV-1) acute retinal necrosis who had a history of neonatal HSV-1 herpetic encephalitis.
An 18-years old male patient with cerebral sequelae and mental retardation secondary to neonatale herpetic encephalitis and Tourette's syndrome was referred to Ankara Ulucanlar Eye Research Hospital for his retinal lesion detected in a primary care centre.
Detailed ophthalmologic examinations and retinal imagings were performed at presentation. He was immediately hospitalized and systemic antiviral treatment was started after humour acqueous was gathered and polymerase chain reaction (PCR) was performed. DNA was extracted from the patient's sample by using DNeasy Blood and Tissue Kit (Qiagen, USA), and the presence of viral pathogens were investigated by using the Seegene Menengitis ACE Detection Kit (Seegene, Korea) according to the manifacturer's instructions. His detailed ophthalmologic examinations and medical treatment adjustments were done in every follow-up visit.
His visual acuities couldn't be evaluated due to his mental retardation. Biomicroscopic anterior segment examination showed normal findings. Retinal examination revealed focal retinitis in the inferior quadrant of his left eye (Figure 1,2). PCR analysis of acqueous sample showed an intense band in the V1 panel representing the presence of HSV-1 (Figure 3). HSV-1 has also been reported in his BOS samples at the time of encephalitis. He was hospitalized and systemic antiviral treatment of intraveous acyclovir was initiated immeadiately, and continued for one month followed by oral acyclovir with tapering dosage for 1 year. His retinal lesion healed with a localized retinal scar (Figure 4)
HSV-1 is a common cause of acute retinal necrosis, however delayed onset years after neonatale encephalitis is rare. Late recurrences of herpetic disease in the retina should be suspected and treated aggressively with antiviral medications in patients with retinitis and a history of previous encephalitis.