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Reminder of important clinical lesson
CASE REPORT
Sequential retinal necrosis secondary to varicella zoster in unrecognised long-standing HIV infection: patient safety report
  1. Brigid KY Ning1,
  2. Simon P Kelly1,
  3. Celia Chu2,
  4. Emile Morgan3
  1. 1Department of Ophthalmology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
  2. 2Department of Microbiology, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
  3. 3Department of Genitourinary Medicine, Royal Bolton Hospital NHS Foundation Trust, Bolton, UK
  1. Correspondence to Dr Brigid KY Ning, logical203{at}hotmail.com

Summary

A retired woman with left ophthalmic shingles of over 2 years’ duration attended with bilateral vision loss and systemic upset. Acute retinal necrosis with detachment was detected on right fundus examination. Cataract in left eye precluded funduscopy. Ocular ultrasonography revealed fibrotic retinal detachment in the left eye. MRI brain and orbits also showed signals of retinal detachment. No abnormal MRI signal within the optic nerve or brain was found. Varicella zoster virus was detected in ocular aqueous and blood samples. High-dose intravenous acyclovir was administered. HIV test was positive with a very low CD4 count. Antiretroviral medications were prescribed. There was no recovery of vision. She was certified as blind, and social services were involved in seeking to provide alterations to her home in view of her severe disability. This case highlights the importance of suspecting HIV in patients with severe or chronic ophthalmic shingles. Images and implications for clinical practice are presented.

  • Hiv / Aids
  • ophthalmology
  • retina
  • sexual transmitted infections (viral)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-222237

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    Footnotes

    • Contributors BN and SPK: literature search, figures, data collection, data interpretation, writing up paper, proof reading, revision and final approval of version. CC: provided images, data interpretation, drafting of manuscript and final approval of version. EM: literature search, data collection, data interpretation, revision of paper and final approval of version.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.