Published date: Dec 31 2024

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: Oct–Dec 2024, Volume 19, Issue 4

Pages: 508 – 511

DOI: 10.18502/jovr.v19i4.8579

Kiana Hassanpourkiana.hassanpour@gmail.comOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Faezeh Khorasanizadehfa.khorasanizadeh@gmail.comAdvanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran

Mahmood Nabavimahmoodnabavi53@yahoo.comDepartment of Infectious Disease, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Narsis Daftariannardaftarian@gmail.comOphthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Alireza Ramezaniarramezani@gmail.comOphthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Purpose: To report the coincidence of acute retinal necrosis (ARN) syndrome following acute meningoencephalitis and presumed coronavirus disease 2019 (COVID-19) in an immunocompetent patient.
Case Report: A 58-year-old female presented to our emergency department with sudden unilateral visual loss following a recent hospitalization for viral meningoencephalitis. Magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, polymerase chain reaction (PCR) of the aqueous humor, reverse transcription polymerase chain reaction (RTPCR) of the nasopharyngeal swab specimen, chest computed tomography (CT), and fundus photography were performed for the patient. 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 aqueous humor PCR was positive for varicella zoster virus (VZV). The patient received a single intravitreal ganciclovir injection and 10 days of intravenous ganciclovir, followed by oral acyclovir. The patient underwent COVID-19 screening tests: while the chest CT scan showed features highly suggestive of COVID-19, the RT-PCR was negative on two occasions. Two months later, best-corrected visual acuity improved to 20/70 in the right eye, the anterior chamber reaction and keratic precipitates resolved, and the vitreous haze decreased significantly.
Conclusion: A case of VZV-induced ARN following acute meningoencephalitis was observed in association with presumed COVID-19. This could be an incidental finding during the COVID-19 pandemic; however, it could also suggest that COVID-19 might trigger ARN in cases with latent herpes family viruses.

Keywords: Acute Retinal Necrosis, Case Report, Coronavirus Disease 2019, Meningoencephalitis, Varicella Zoster Virus

1. Culbertson WW, Blumenkranz MS, Haines H, Gass DM, Mitchell KB, Norton EW. The acute retinal necrosis syndrome. Part 2: Histopathology and etiology. Ophthalmology 1982;89:1317–1325.

2. Ahmadieh H, Sajjadi SH, Azarmina M, Kalani H. Association of herpetic encephalitis with acute retinal necrosis syndrome. Ann Ophthalmol 1991;23:215–219.

3. Pavésio CE, Conrad DK, McCluskey PJ, Mitchell SM, Towler HM, Lightman S. Delayed acute retinal necrosis after herpetic encephalitis. Br J Ophthalmol 1997;81:415– 416.

4. Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis 2020;94:55–58.

5. Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19–Associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features. Radiology 2020;296:E119–E120.

6. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RTPCR. Radiology 2020;296:E115–E117.

7. Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics 2018;38:719–739.

8. Bai HX, Hsieh B, Xiong Z, Halsey K, Choi JW, Tran TM, et al. Performance of radiologists in differentiating COVID-19 from viral pneumonia on chest CT. Radiology 2020;296:E46–E54.

9. Nagel MA, Niemeyer CS, Bubak AN. Central nervous system infections produced by varicella zoster virus. Curr Opin Infect Dis 2020;33:273–278.

10. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020;87:18– 22.