PMID- 37390266
OWN - NLM
STAT- MEDLINE
DCOM- 20230703
LR  - 20230916
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 102
IP  - 26
DP  - 2023 Jun 30
TI  - Pigmentary retinopathy and nodular granuloma associated with acute retinal 
      necrosis from varicella zoster virus and human herpes virus type 6: Case report.
PG  - e33958
LID - 10.1097/MD.0000000000033958 [doi]
LID - e33958
AB  - RATIONALE: Acute retinal necrosis (ARN) caused by human herpes virus type 6 
      (HHV-6) is uncommon. We described a case of consecutive bilateral ARN, which was 
      found to be a coinfection of varicella zoster virus (VZV) and HHV-6 in a 
      50-year-old woman, not well responded with systemic acyclovir. We showed the 
      atypical findings with corresponding fundus and optical coherence tomography 
      imaging. PATIENT CONCERNS: She presented with anterior segment inflammation with 
      peripheral retinitis and vasculitis in the left eye with disease progression 
      despite of initial antiviral treatment, end up with retinal detachment. The right 
      eye, subsequently, developed focal retinitis. DIAGNOSIS: ARN was diagnosed by 
      clinical fundus picture, confirmed by polymerase chain reaction (PCR). 
      INTERVENTIONS: Initially, she was treated with intravenous acyclovir and 
      intravitreal ganciclovir for left eye. Retinal necrosis progressed, followed by 
      retinal detachment. Pars plana vitrectomy with silicone oil was performed. The 
      right eye, subsequently, developed focal retinitis. Medication was switched to 
      intravenous ganciclovir and then oral valganciclovir. OUTCOMES: Retinitis was 
      resolved, generalized hyperpigmentation appeared as a salt-and-pepper appearance 
      in the right eye. The left eye presented preretinal deposits on silicone-retina 
      interphase along retinal vessels. Spectral-domain optical coherence tomography 
      (SD-OCT) showed multiple hyperreflective nodules on retinal surface. LESSONS: ARN 
      from coinfection of VZV and HHV-6 is rare. Preretinal granulomas and generalized 
      hyperpigmentation could be one of the HHV-6 features. HHV-6 should be in the 
      differential diagnosis for ARN. It responds well to systemic ganciclovir.
CI  - Copyright (c) 2023 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Keorochana, Narumon
AU  - Keorochana N
AUID- ORCID: 0000-0001-7937-7406
AD  - Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of 
      Medicine, Bangkok, Thailand.
FAU - Suleesathira, Budsarat
AU  - Suleesathira B
FAU - Vongkulsiri, Sritatath
AU  - Vongkulsiri S
AUID- ORCID: 0000-0002-3251-0895
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - X4HES1O11F (Acyclovir)
RN  - P9G3CKZ4P5 (Ganciclovir)
SB  - IM
MH  - Female
MH  - Humans
MH  - Middle Aged
MH  - *Retinal Necrosis Syndrome, Acute/diagnosis/drug therapy
MH  - Herpesvirus 3, Human
MH  - *Retinal Detachment
MH  - *Coinfection
MH  - *Herpesvirus 6, Human
MH  - *Retinitis Pigmentosa
MH  - Retina
MH  - *Retinitis
MH  - Acyclovir
MH  - Ganciclovir/therapeutic use
PMC - PMC10313261
COIS- The authors have no funding and conflicts of interest to disclose.
EDAT- 2023/06/30 19:14
MHDA- 2023/07/03 06:42
PMCR- 2023/06/30
CRDT- 2023/06/30 14:13
PHST- 2023/07/03 06:42 [medline]
PHST- 2023/06/30 19:14 [pubmed]
PHST- 2023/06/30 14:13 [entrez]
PHST- 2023/06/30 00:00 [pmc-release]
AID - 00005792-202306300-00038 [pii]
AID - 10.1097/MD.0000000000033958 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2023 Jun 30;102(26):e33958. doi: 
      10.1097/MD.0000000000033958.