Meenakashi Gupta1, Maria Stephanie R Jardeleza2, Ivana Kim3, Marlene L Durand4, Leo Kim3, Ann-Marie Lobo5. 1. a Department of Ophthalmology , Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA . 2. b Texas Diabetes Institute, Department of Ophthalmology, University of Texas Health Sciences Center , San Antonio , Texas , USA . 3. c Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA . 4. d Department of Infectious Disease , Massachusetts General Hospital , Boston , Massachusetts , USA , and. 5. e Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary , Boston , Massachusetts , USA.
Abstract
PURPOSE: Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia. METHODS: Clinical presentation, examination, imaging, and laboratory testing of two patients with VZV retinitis are presented. RESULTS: An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm(3). A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZV retinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm(3). CONCLUSIONS: VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.
PURPOSE: Progressive outer retinal necrosis (PORN) associated with varicella zoster virus (VZV) is usually diagnosed in HIV positive or immunosuppressed patients. We report two cases of immunocompetent patients with necrotizing viral retinitis found to have idiopathic CD4 lymphocytopenia. METHODS: Clinical presentation, examination, imaging, and laboratory testing of two patients with VZVretinitis are presented. RESULTS: An HIV negative patient with history of herpes zoster presented with rapid loss of vision and examination consistent with PORN. PCR testing confirmed VZV. Lymphocytopenia was noted with a CD4 count of 25/mm(3). A second HIV negative patient presented with blurred vision and lid swelling and was found to have peripheral VZVretinitis confirmed by PCR. Laboratory workup revealed lymphocytopenia with a CD4 count of 133/mm(3). CONCLUSIONS:VZV necrotizing retinitis classic for PORN can occur in HIV negative patients. Idiopathic CD4 lymphocytopenia should be considered healthy patients who develop ocular infections seen in the immunocompromised.
Authors: Matthew R Debiec; Aaron T Lindeke-Myers; Jessica G Shantha; Chris S Bergstrom; G Baker Hubbard; Steven Yeh Journal: Ophthalmol Retina Date: 2020-07-16