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Xiaoyan Peng, Feng Hu, Ningli Wang; Bilateral Acute Retinal Necrosis Shown in Patients with Viral Encephalitis: a Possible Potential Pathogen Related with Pig. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3607.
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To investigate the ocular and neurologic characteristics of a series of ARN closely following viral encephalitis which might be associated with occupational exposure to pigs.
Detailed medical history, clinical and imaging data as well as laboratory results of the patients in our case series in both eye and neurologic clinic were retrospectively analyzed.
Totally 11 patients (medium 33 years old, range 24-53 years) with 7 males and 4 females were included in our study. All of the patients were bilaterally affected at the initial visit at the eye clinic. Nine out of the 11 patients complained of visual loss immediately after awaking from unconsciousness. Only 1 eye preserved central vision with best corrected visual acuity (BCVA) of 20/100, while all of the other eyes were worse than counting finger, and moreover 14 eyes of 9 patients displayed no light perception (NLP). All of the patients showed vitreous haze and 12 eyes of 7 patients were with dense opacity and fundi were not visible. The major ocular changes included pale optic disk (8/10), extensive narrowing and whitening of retinal arteries (5/10) and peripheral retinal necrosis (4/10). Retinal detachment (RD) was detected in 20 eyes in the 10 patients. The neurological manifestations were exhibited as high fever and persistent unconsciousness (medium 21 days, range 0-75 days). Laboratory analysis of cerebrospinal fluid (CSF) suggested probable viral infection in 9 patients, while no evidence of specific pathogens detected in CSF and ocular fluid. All the patients except one unknown had occupational exposure to pigs, and in 9 cases the encephalitis occurred from Feb to Apr.
Symmetrically involved ARN with poor visual prognosis was found closely related to encephalitis and occupational exposure to pigs, which was different from the previously reported ARN. The etiology of the case series needs further investigation as it may be associated with pathogen other than herpetic viruses.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
The right fundus imaging of ARN patient
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