A clinical case of multifocal chorioretinitis associated with Herpes zoster

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Abstract

The Varicella-Zoster virus (VZV) is the etiologic agent of one of the most common infectious diseases among children, chickenpox. In its recurrent form it may cause a far more devastating disease, Herpes zoster. The disease can be manifested as conjunctivitis, episcleritis, scleritis, keratitis, anterior uveitis. Chorioretinal lesions may occur in patients with immunosuppression.

A 14-year-old male patient has been admitted to the Ophthalmologic center after S.V. Malayan with complaints of visual decrease, redness and pains. In the history of the patient the transferred chickenpox was marked a few months ago. By biomicroscopic and fundoscopic examination conjunctival hyperemia, corneal precipitates, severe inflammatory reaction in the anterior chamber, sectoral iris atrophy, posterior synechiae, yellow-white multifocal, peripheral lesions on the fundus of both eyes and pigmented macular scar in the right eye were found out. Laboratory tests showed high levels of anti-VZV IgG. Treatment was prescribed in the form of local instillations and subtenon injections, as well as antiviral tablets. As a result of treatment, remission of inflammatory process and improvement of visual acuity were registered. The specific characteristic of present case study is the description of single clinical manifestations of Herpes zoster, which are necessary to detect for correct and timely treatment.

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About the authors

Svetlana S. Martirosyan

S.V. Malayan Ophthalmologic Сenter; Mkhitar Heratsi Yerevan State Medical University

Author for correspondence.
Email: martirosyan.svetlana@mail.ru
ORCID iD: 0000-0002-4858-4450

MD, PhD, ophthalmologist of the External Diseases and Cornea-Uveitis Department; lecturer of the Ophthalmology Department

Armenia, Yerevan; Yerevan

Ofelya B. Ginoyan

S.V. Malayan Ophthalmologic Сenter; Mkhitar Heratsi Yerevan State Medical University

Email: ofelya.ginoyan.b@mail.ru
ORCID iD: 0000-0001-6077-6079

MD, ophthalmologist of the External Diseases and Cornea-Uveitis Department; assistant lecturer of the Ophthalmology Department

Armenia, Yerevan; Yerevan

Anna V. Hovakimyan

S.V. Malayan Ophthalmologic Сenter; Mkhitar Heratsi Yerevan State Medical University

Email: ahovakimyan@yahoo.com
ORCID iD: 0000-0003-3921-6960

MD, PhD, head of the External Diseases and Cornea-Uveitis Department; professor of the Ophthalmology Department

Armenia, Yerevan; Yerevan

Diana R. Simonyan

S.V. Malayan Ophthalmologic Сenter; Mkhitar Heratsi Yerevan State Medical University

Email: dianasimo@mail.ru
ORCID iD: 0000-0002-0743-5053

MD, ophthalmologist of the External Diseases and Cornea-Uveitis Department; assistant of the Ophthalmology Department

Armenia, Yerevan; Yerevan

Ilona K. Musheghyan

Mkhitar Heratsi Yerevan State Medical University

Email: imushegyan7@mail.ru
ORCID iD: 0000-0002-5879-3715

oncology resident

Armenia, Yerevan

References

  1. Weller TH. Varicella and Herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. N Engl J Med. 1983;309(23):1434–1440. doi: 10.1056/NEJM198312083092306
  2. Davison AJ. Varicella-zoster virus. The Fourteenth Fleming lecture. J Gen Virol. 1991;72(3):475–486. doi: 10.1099/0022-1317-72-3-475
  3. Liesegang TJ. Diagnosis and therapy of herpes zoster ophthalmicus. Ophthalmology. 1991;98(8):1216–1229. doi: 10.1016/s0161-6420(91)32163-8
  4. Hope-Simson RE. The nature of Herpes Zoster: a long-term study and a new hypothesis. J Proceed R Soc Med. 1965;58(1):9–20. doi: 10.1177/003591576505800106
  5. Hyndiuk R, Glasser D. Herpes simplex keratitis. In: Tabbara KF, Hyndiuk R, editors. Infections of the Eye, 1st edition. Boston, MA: Little Brown and Company, 1986. 715 p.
  6. Cobo M, Foulks GN, Liesegang T, et al. Observations on the natural history of herpes zoster ophthalmicus. Curr Eye Res. 1987;6(1):195–199. doi: 10.3109/02713688709020090
  7. Browning DJ, Blumenkranz MS, Culbertson WW, et al. Association of varicella zoster dermatitis with acute retinal necrosis syndrome. Ophthalmology. 1987;94(6):602–606. doi: 10.1016/s0161-6420(87)33405-0
  8. Urayama A, Yamada N, Sasaki T et al. Unilateral acute uveitis with retinal periarteritis and detachment. Jpn J Ophthalmol. 1971;25:607–619.

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Herpes zoster ophthalmicus. Biomicroscopic examination; a — right eye; b — left eye

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3. Fig. 2. Herpes zoster ophthalmicus. Fundoscopic examination: a — right eye; b — left eye

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4. Fig. 3. Right eye. Fundoscopic examination. Pigmented macular scar

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5. Fig. 4. Computed tomography scan of lungs

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6. Fig. 5. Herpes zoster ophthalmicus. Fundus after the treatment: a — right eye; b — left eye

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7. Fig. 6. OCT examination before treatment: a — right eye; b — left eye

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8. Fig. 7. Left eye. OCT examination after treatment

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