Varicella Zoster Virus Induced Acute Retinal Necrosis Following Acute Meningoencephalitis in a Patient with Presumed COVID-19
Kiana Hassanpour1 , Faezeh Khorasanizadeh 2 , Hamid Ahmadieh 1 , Mahmood Nabavi 2 , Narsis Daftarian1 , Alireza Ramezani 3 *
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences
- Department of ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: To report the coincidence of acute retinal necrosis syndrome (ARN) following acute meningoencephalitis and presumed coronavirus disease 2019 (COVID-19) in an immunocompetent patient.
Methods: A 58-year old female presented to our emergency department complaining of sudden unilateral visual loss following a recent hospitalization for a viral meningoencephalitis. Magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcriptase polymerase chain reaction (RT-PCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient.
Results: Ophthalmic examination revealed severe ocular inflammation and yellowish patches of necrotizing retinitis in the right eye compatible with the diagnosis of ARN. The result of PCR on the aqueous humor was positive for VZV. The patient received one intravitreal ganciclovir injection and 10 days intravenous ganciclovir followed by oral acyclovir. The patient underwent COVID-19 screening tests; chest CT-scan showed the features highly suggestive for COVID-19 while the RT-PCR was negative two times. Two months later, BCVA reached 20/70 in the right eye. The anterior chamber reaction and KPs resolved and the vitreous haziness significantly decreased
Conclusion: A case of VZV induced ARN following acute meningoencephalitis was observed in association with presumed COVID-19. This could be an incidental finding in the pandemic era of COVID-19; however, it could also suggest that COVID-19 might trigger ARN in cases having latent herpes family viruses.
