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Bilateral acute retinal necrosis associated with neuroinfection in patient after renal transplantation.

Brydak-Godowska J, Szczepanik S, Ciszek M, Bialas D, Grzeszczyk M, Strzeleck D, Kecik D - Med. Sci. Monit. (2011)

Bottom Line: In MRI T2-mode, inflammatory changes were found in the white matter of the right hemisphere.The patient was treated with systemic acyclovir, itraconazole, metronidazole and ciprofloxacin for 3 weeks.Retinal detachment was observed in both eyes.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland. joannabg@tlen.pl

ABSTRACT

Background: Acute retinal necrosis (ARN) is characterized by the triad of acute vitritis, peripheral necrotizing retinitis and vasculitis.

Case report: We report a case of 54-year-old woman with bilateral acute retinal necrosis associated with neuroinfection. Her past medical history included renal transplantation, hypertension and aortic stenosis. Observational case report: Diagnostic investigations included biochemical tests, lumbar puncture, eye ultrasonography and MRI of the brain. Anti-HSV IgG antibody titers were elevated in the blood and cerebrospinal fluid. In MRI T2-mode, inflammatory changes were found in the white matter of the right hemisphere. The patient was treated with systemic acyclovir, itraconazole, metronidazole and ciprofloxacin for 3 weeks. Retinal detachment was observed in both eyes.

Conclusions: Acute retinal necrosis can be the single manifestation of herpes virus reactivation in patients after organ transplantation.

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Related in: MedlinePlus

Focus of inflammation in the central nervous system seen in NMR scan.
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f3-medscimonit-17-8-cs99: Focus of inflammation in the central nervous system seen in NMR scan.

Mentions: In early December 2007 the patient was admitted to the Department of Ophthalmology for vitrectomy in the right eye. On admission she was found to suffer from thought disorder and memory impairment. The patient gave a history of deteriorating vision in the left eye for 3 weeks but could not explain why she had not consulted an ophthalmologist. On examination, BCVA for distance of the right eye was 0.02 and 0.06 of the left eye. The patient was not able to read with her right eye and best corrected visual acuity for reading in the left eye was only 3.0. The eyeballs were pale, scattered pigment deposits were seen on opacities of the lenses, and the left iris was dilated without mydriatics. In the vitreous bodies of both eyes massive exudate was seen with numerous floaters. Vitrectomy was adjourned because of the general condition of the patient. Systemic treatment was used: acyclovir IV 500 mg once daily, metronidazole IV 500 mg bid, Proxacin (ciprofloxacin) IV 250 mg once daily, oral itraconazole 100 mg once daily and topical dexamethasone 1% and Naclof instilled into both eyes tid. MRI of the brain was performed and in scans in a T-2 mode a hyperintense area was identified in the white matter of the right hemisphere above the lateral ventricle extending along its entire length, with discrete patchy contrast enhancement of the lesion corresponding to encephalitis. In T-2 mode scans, small hyperintense foci were seen in the white matter of both hemispheres (vascular changes; Figure 3)


Bilateral acute retinal necrosis associated with neuroinfection in patient after renal transplantation.

Brydak-Godowska J, Szczepanik S, Ciszek M, Bialas D, Grzeszczyk M, Strzeleck D, Kecik D - Med. Sci. Monit. (2011)

Focus of inflammation in the central nervous system seen in NMR scan.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539611&req=5

f3-medscimonit-17-8-cs99: Focus of inflammation in the central nervous system seen in NMR scan.
Mentions: In early December 2007 the patient was admitted to the Department of Ophthalmology for vitrectomy in the right eye. On admission she was found to suffer from thought disorder and memory impairment. The patient gave a history of deteriorating vision in the left eye for 3 weeks but could not explain why she had not consulted an ophthalmologist. On examination, BCVA for distance of the right eye was 0.02 and 0.06 of the left eye. The patient was not able to read with her right eye and best corrected visual acuity for reading in the left eye was only 3.0. The eyeballs were pale, scattered pigment deposits were seen on opacities of the lenses, and the left iris was dilated without mydriatics. In the vitreous bodies of both eyes massive exudate was seen with numerous floaters. Vitrectomy was adjourned because of the general condition of the patient. Systemic treatment was used: acyclovir IV 500 mg once daily, metronidazole IV 500 mg bid, Proxacin (ciprofloxacin) IV 250 mg once daily, oral itraconazole 100 mg once daily and topical dexamethasone 1% and Naclof instilled into both eyes tid. MRI of the brain was performed and in scans in a T-2 mode a hyperintense area was identified in the white matter of the right hemisphere above the lateral ventricle extending along its entire length, with discrete patchy contrast enhancement of the lesion corresponding to encephalitis. In T-2 mode scans, small hyperintense foci were seen in the white matter of both hemispheres (vascular changes; Figure 3)

Bottom Line: In MRI T2-mode, inflammatory changes were found in the white matter of the right hemisphere.The patient was treated with systemic acyclovir, itraconazole, metronidazole and ciprofloxacin for 3 weeks.Retinal detachment was observed in both eyes.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland. joannabg@tlen.pl

ABSTRACT

Background: Acute retinal necrosis (ARN) is characterized by the triad of acute vitritis, peripheral necrotizing retinitis and vasculitis.

Case report: We report a case of 54-year-old woman with bilateral acute retinal necrosis associated with neuroinfection. Her past medical history included renal transplantation, hypertension and aortic stenosis. Observational case report: Diagnostic investigations included biochemical tests, lumbar puncture, eye ultrasonography and MRI of the brain. Anti-HSV IgG antibody titers were elevated in the blood and cerebrospinal fluid. In MRI T2-mode, inflammatory changes were found in the white matter of the right hemisphere. The patient was treated with systemic acyclovir, itraconazole, metronidazole and ciprofloxacin for 3 weeks. Retinal detachment was observed in both eyes.

Conclusions: Acute retinal necrosis can be the single manifestation of herpes virus reactivation in patients after organ transplantation.

Show MeSH
Related in: MedlinePlus