Multimodal Imaging of a Severe Case of Neonatal Acute Retinal Necrosis and Lens Vacuoles Associated with Herpes Simplex Virus Infection

ABSTRACT

Purpose

To report a case of a neonate with acute retinal necrosis, lens vacuoles, and encephalitis associated with herpes simplex virus (HSV) infection.

Design

Case report.

Methods

Retrospective chart review.

Results

A male neonate was brought for screening for retinopathy of prematurity at the corrected age of 32 weeks. Slit-lamp examination showed lens vacuoles in both eyes. Fundus examination revealed extensive retinal detachments with prominent retinal whitening, subretinal exudates, and retinal hemorrhage. Computed tomography of the brain showed encephalomalacia. Polymerase chain reaction of cerebrospinal fluid and anterior chamber fluid was both positive for HSV-1. Despite systemic anti-viral therapy, a rhegmatogenous retinal detachment and subsequent proliferative vitreoretinopathy developed in the patient’s right eye. The retinal detachment in the left eye resolved, but significant chorioretinal degeneration occurred. With time lens vacuoles decreased in number.

Conclusions

Clinicians should remember this rare, but devastating condition without specific prodromal symptoms.

KEYWORDS:

• Acute retinal necrosis
• neonate
• herpes simplex virus
• lens vacuoles
• encephalitis
• exudative retinal detachment

Acknowledgments

We thank Claire Barnes, PhD, from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

Declaration of interest

Takamasa Kinoshita has received lecture fees from Novartis Japan and Santen Pharmaceutical Co., Ltd. Hiroko Imaizumi has received lecture fees from Novartis Japan, Bayer Japan, and Otsuka Pharmaceutical Co., Ltd. The authors alone are responsible for the content and writing of the paper.

Patient consent

The patient’s parents have consented to the submission of this case report to the journal.