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      Bilateral acute retinal necrosis associated with neuroinfection in patient after renal transplantation

      case-report

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          Background

          Acute retinal necrosis (ARN) is characterized by the triad of acute vitritis, peripheral necrotizing retinitis and vasculitis.

          Case Report

          We report a case of 54-year-old woman with bilateral acute retinal necrosis associated with neuroinfection. Her past medical history included renal transplantation, hypertension and aortic stenosis. Observational case report: Diagnostic investigations included biochemical tests, lumbar puncture, eye ultrasonography and MRI of the brain.

          Anti-HSV IgG antibody titers were elevated in the blood and cerebrospinal fluid. In MRI T2-mode, inflammatory changes were found in the white matter of the right hemisphere. The patient was treated with systemic acyclovir, itraconazole, metronidazole and ciprofloxacin for 3 weeks. Retinal detachment was observed in both eyes.

          Conclusions

          Acute retinal necrosis can be the single manifestation of herpes virus reactivation in patients after organ transplantation.

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          Most cited references16

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          Standard diagnostic criteria for the acute retinal necrosis syndrome. Executive Committee of the American Uveitis Society.

          Daniel G Holland (1994)
          Article 0 comments Cited 63 times – based on 0 reviews     Review now
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            Retinal complications in patients with solid organ or bone marrow transplantations.

            Hee-Choon S Lee, Ki Kim, Hyewon Chung … (2007)
            The administration of systemic immunosuppressive agents to recipients of solid organ or bone marrow transplants results in an immunocompromised status. As the number of organ recipients and their life span increase with recent progress in organ transplantation, ocular complications tend to become more diverse and serious. From 1995 to 2005, 3656 cases of organ transplantations were performed at Asan Medical Center. The medical records of 1198 of these patients who had been examined at the Department of Ophthalmology were reviewed. Retinal complications were diagnosed in 33 of the transplant recipients; five with bone marrow transplantation, 16 with kidney transplantation, seven with liver transplantation (LT), and five with heart transplantation. Diagnoses included 11 cases of CMV (cytomegalovirus) retinitis, three of acute retinal necrosis, one of progressive outer retinal necrosis, five of fungal chorioretinitis, one of toxoplasmic retinochoroiditis, three of central retinal vein occlusion, and nine of central serous chorioretinopathy. While CMV, fungal, or toxoplasmic chorioretinitis developed frequently in association with extraocular infection or organ rejection, herpetic infection manifested only in the eye without any rejection. Most infectious cases responded well to the standard therapeutic regimen. Interestingly, central retinal vein occlusion developed exclusively following LT, possibly in relation to coagulation cascade abnormality. To our best knowledge, this comprehensive review presents the largest series of ocular complication in organ transplant recipients. Familiarity with the potential ocular complications as well as a high index of suspicion is warranted to the practicing ophthalmologists.
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              Ocular complications of heart, lung, and liver transplantation.

              P. Ng, P McCluskey, G McCaughan … (1998)
              To document the nature and frequency of ocular complications in a large group of patients who underwent heart, lung, or liver transplantation.
              Article 0 comments Cited 13 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Sci Monit
                Journal ID (iso-abbrev): Med. Sci. Monit
                Journal ID (publisher-id): Medical Science Monitor
                Title: Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                Publisher: International Scientific Literature, Inc.
                ISSN (Print): 1234-1010
                ISSN (Electronic): 1643-3750
                Publication date Collection: 2011
                Publication date (Electronic): 01 August 2011
                Volume: 17
                Issue: 8
                Pages: CS99-CS102
                Affiliations
                [1 ]Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
                [2 ]Chair and Department of General and Experimental Pathology, Medical University of Warsaw, Warsaw, Poland
                [3 ]Department of Immunology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
                [4 ]Department of Transplant Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland
                [5 ]Department of Infectious Diseases, Warsaw Hospital for Infectious Diseases, Warsaw, Poland
                Author notes
                Joanna Brydak-Godowska, Department of Ophthalmology, Medical University of Warsaw, Lindley 4 Str., 02-005 Warsaw, Poland, e-mail: joannabg@ 123456tlen.pl
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                Publisher ID: 881890
                DOI: 10.12659/MSM.881890
                PMC ID: 3539611
                PubMed ID: 21804470
                SO-VID: 38bf2543-5a9b-4e29-8743-7d46ca68c834
                Copyright © © Med Sci Monit, 2011
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

                History
                Date received : 09 April 2010
                Date accepted : 01 March 2011
                Categories
                Subject: Case Study

                Keywords: acute retinal necrosis,renal transplantation,immunosupression,neuroinfection
                Data availability:
                Keywords: acute retinal necrosis, renal transplantation, immunosupression, neuroinfection

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