Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome
S. M. Friedlander, F. M. Rahhal, L. Ericson, J. F. Arevalo, J. D. Hughes, L. Levi, C. A. Wiley, E. M. Graham, W. R. Freeman and J. F. Arrevalo
Department of Pathology, University of California, San Diego, La Jolla, USA.
OBJECTIVE: To describe the clinical course of varicella-zoster optic
neuropathy preceding acute retinal necrosis in patients with acquired
immunodeficiency syndrome. DESIGN: Case series. SETTING: Two tertiary care
centers in San Diego, Calif, and London, England. PATIENTS: Three human
immunodeficiency virus-positive men with previous cutaneous zoster
infection, optic neuropathy, and necrotizing retinitis. RESULTS: All
patients had an episode of zoster dermatitis treated with acyclovir. Visual
loss consistent with an optic neuropathy ensued, followed by typical
herpetic retinitis. The cause of visual loss was not suspected to be
varicella-zoster until after the retinitis occurred. Despite aggressive
medical treatment, 4 of 6 eyes progressed to retinal detachment.
CONCLUSIONS: Varicella-zoster may cause an optic neuropathy in patients
with acquired immunodeficiency syndrome, especially in those with previous
shingles. A high index of suspicion is necessary to establish the diagnosis
and begin early antizoster treatment.
