J Korean Ophthalmol Soc.  2017 Nov;58(11):1295-1300. 10.3341/jkos.2017.58.11.1295.

Two Cases of Acute Retinal Necrosis after Viral Meningitis

• Park WK
• Baek JW
• Ra H

• KMID: 2395873
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1295

Abstract

PURPOSE
To report two cases of acute retinal necrosis following viral meningitis.
CASE SUMMARY
A 52-year-old woman who has had viral meningitis presented with visual loss of right eye. Slit-lamp examination showed conjunctival injection and inflammatory cells (2+) in the anterior chamber of the right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed early hypofluorescence and the late vascular leak in the peripheral retina. After the patient was diagnosed with Acute retinal necrosis (ARN), intravenous acyclovir (2,100 mg/m²/day) was administered. During the treatment period, the retinal detachment of the right eye was found, so the authors performed pars plana vitrectomy. After the surgery, new retinal lesions weren't observed in both eyes during follow-up. A 57-year-old man previously treated with possible viral meningitis presented with visual loss of his right eye. Funduscopic examination showed multiple yellow-whitish spots in the peripheral retina. Fluorescein fundus angiography showed the late vascular leak in the peripheral retina. In the systemic evaluation, Herpes simplex virus and Cytomegalovirus immunoglobulin G were detected. With the impression of ARN, intravenous acyclovir (2,100 mg/m²/day) was administered. No new retinal lesions were observed in both eyes during follow-up.
CONCLUSIONS
We report rare cases of ARN occurring after viral meningitis. Uveitis in patients with recent history of meningitis should be examined carefully under the suspicion of ARN.

Keyword

Acute retinal necrosis; Meningitis; Viral meningitis

MeSH Terms

Acyclovir
Angiography
Anterior Chamber
Cytomegalovirus
Female
Fluorescein
Follow-Up Studies
Humans
Immunoglobulin G
Meningitis
Meningitis, Viral*
Middle Aged
Retina
Retinal Detachment
Retinal Necrosis Syndrome, Acute*
Retinaldehyde
Simplexvirus
Uveitis
Vitrectomy
Acyclovir
Fluorescein
Immunoglobulin G
Retinaldehyde

Figure

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  Figure 1 Brain Magnetic Resonance Imaging of 1st case patient. T1-weighted sequence following contrast consistent with meningeal enhancement representing viral meningitis.

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  Figure 2 Ultra-widefield imaging and ultra-widefield fluorescein angiography of 1st case patient. (A, B) Initial ultra-widefield imaging showing multiple yellow-whitish spots in the peripheral retina. (C, D) Initial ultra-widefield fluorescein angiography. Early hypofluorescence (C) and late vascular leak (D) in the peripheral retina. (E) After 2 days of oral antivirals, retinal necrosis progression. (F) After 1 week of intravenous antivirals, peripheral necrotic lesions regressed.

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  Figure 3 Ultra-widefield imaging and ultra-widefield fluorescein angiography of 2nd case patient. (A) Initial ultra-widefield imaging showing infiltration of inflammatory cells at the peripheral retina. (B) After 12 weeks of treatment, no complications like retinal detachment or retinal hemorrhage. (C, D) Initial ultra-widefield fluorescein angiography showing late vascular leak at the peripheral retina.

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