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July 1996

Acquired Immunodeficiency Syndrome—Associated Herpes Simplex Virus Retinitis: Clinical Description and Use of a Polymerase Chain Reaction—Based Assay as a Diagnostic Tool

Author Affiliations

From the Francis I. Proctor Foundation (Drs Cunningham and Margolis and Mr Short) and the Department of Ophthalmology (Drs Cunningham, Irvine, and Margolis), School of Medicine, University of California—San Francisco, and the Department of Ophthalmology, New England Eye Center, Tufts University School of Medicine, Boston, Mass (Dr Duker).

Arch Ophthalmol. 1996;114(7):834-840. doi:10.1001/archopht.1996.01100140048006

Objectives:  To describe 2 patients with acquired immunodeficiency syndrome who experienced a rapidly progressive, bilateral retinitis due to herpes simplex virus (HSV) (1 case due to HSV type 1 [HSV-1] and 1 case due to HSV type 2 [HSV-2]) and to present a novel diagnostic polymerase chain reaction (PCR)—based assay.

Methods:  The presentation, clinical course, and diagnostic PCR-based assay used to make the diagnosis of HSV retinitis in 2 patients with acquired immunodeficiency syndrome are described.

Results:  Both patients experienced a rapidly progressive, bilateral retinal necrosis associated with intraretinal hemorrhages and a diffuse vasculitis. The PCR-based assays demonstrated HSV DNA in the vitreous specimens from the 2 patients. Restriction analysis on the amplified DNA showed HSV-1 in 1 patient and HSV-2 in the second patient. The diagnosis was supported in both patients by the occurrence of a herpes simplexlike encephalitis, and in 1 patient by a positive vitreous culture. The HSV-1—associated vasculitis affected primarily the retinal arterioles, with marked capillary dropout and occlusion of larger arcade vessels. In contrast, the HSV-2—associated vasculitis affected the retinal veins more than the arterioles, and was associated with an exudative retinal detachment.

Conclusions:  To our knowledge, these are the first 2 patients with acquired immunodeficiency syndrome in whom HSV has been implicated as the sole cause of a rapidly progressing, necrotizing retinitis. Combined PCR and restriction analysis of vitreous samples from such patients is a useful and highly specific means of diagnosing HSV-1 and HSV-2 retinitis.

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