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Park, Baek, and Ra: Two Cases of Acute Retinal Necrosis after Viral Meningitis
Case Report

Journal of the Korean Ophthalmological Society 2017; 58(11): 1295-1300.

Published online: 15 November 2017

DOI: https://doi.org/10.3341/jkos.2017.58.11.1295

Two Cases of Acute Retinal Necrosis after Viral Meningitis

Woo Kyung Park, MD, Ji Won Baek, MD, Ho Ra, MD

Department of Ophthalmology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.

Address reprint requests to Ho Ra, MD. Department of Ophthalmology, The Catholic University of Korea Bucheon St. Mary's Hospital, #327 Sosa-ro, Bucheon 14647, Korea. Tel: 82-32-340-2125, Fax: 82-32-340-2126, raho@catholic.ac.kr

Received 27 April 2017       Revised 11 September 2017       Accepted 19 October 2017

©2017 The Korean Ophthalmological Society

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Acute retinal necrosis, Meningitis, Viral meningitis

Figures and Tables

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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Notes

Conflicts of Interest The authors have no conflicts to disclose.

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