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E.W. Fitz, S.A. Newman, B.P. Conway; A Unique Case of HSV–2 Acute Retinal Necrosis Masquerading as Orbital Cellulitis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1031.
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Purpose: To describe a case of PCR proven HSV–2 mediated Acute Retinal Necrosis (ARN) who initially presented with orbital signs. Methods: An 11 year old girl intially presented with a one week history of a red left eye. She was diagnosed with conjunctivitis and started on anti–microbial coverage. The following day, she was noted to have periorbital edema. The view of the left fundus was hazy secondary to vitritis, but scattered white retinal infiltrates could be appreciated. She was seen in consult by neuro–ophthalmology service: a clinical diagnosis of orbital cellulitis was made on the basis of proptosis, chemosis, limitation in motility, and an rAPD OS. There was no view of the posterior pole in the left eye. The patient was treated with intravenous antibiotics for a presumed bacterial orbital cellulitis, and discharged with a PICC line for treatment at home. Her clinical situation regressed when the antibiotics were discontinued. At her next examination, slit lamp examination of the left eye showed 3+ cell and flare. The left lens was clear. The vitreous was cloudy. The left fundus showed opacification of the peripheral retinal in confluent patches for 360 degrees. There was clear perivascular involvement. B–Scan of the left eye showed no retinal detachment, increased vitreous echoes and thickened sclera. Results: The clinical diagnosis of ARN was made and the patient was admitted to the hospital for IV acyclovir. An Anterior Chamber tap was performed and PCR testing of the fluid was positive for HSV–2. The patient was discharged on Acyclovir 300 mg IV q 8 hrs for ten days, and then was to be switched to oral Famvir. Conclusions: After a review of the literature, we believe this case to represent the first reported case of HSV–2 mediated ARN initially presenting with orbital involvement.
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