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Case report
Acute retinal necrosis by herpes simplex virus type 1: an unusual presentation of a primary infection
  1. Gonçalo Pereira Cruz1,
  2. Cristina Fonseca2,
  3. Joaquim Oliveira1 and
  4. José Saraiva da Cunha1
  1. 1 Infectious Diseases, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
  2. 2 Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  1. Correspondence to Dr Gonçalo Pereira Cruz; gpereiracruz{at}


Herpes simplex virus (HSV) can affect the central nervous system causing meningitis, encephalitis and, rarely, acute retinal necrosis. We present a case of a 46-year-old man, previously healthy complaining of a 5-day persistent headache and sudden loss of vision of his left eye that progressed to the right. We started ceftriaxone, methylprednisolone and acyclovir for suspected encephalitis with vasculitis. HSV-1 was identified in vitreous and aqueous humour. Therapy with acyclovir was maintained and two intravitreous boluses of foscarnet were administered, without improvement. Usually being a benign infection, HSV can, in rare cases like this, have catastrophic effects in the optic tract.

  • infectious diseases
  • cranial nerves
  • neuroopthalmology
  • retina
  • visual pathway

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  • Contributors The first author, GPC, interviewed the patient and aquired the data (clinical history, physical exam, results of the exams and so on). He also projected, designed the step-by-step approach to the case and wrote the article. He obtained the MRI image that is shown in the figure file. After all of the other authors gave suggestions and proofread the article, GPC put everything together and submitted the article.The second author, CF, provided help in the descriptions of the opthamological pathology, as well as, both images of the fundus of the eyes. She also revised and helped proofreading the text. The third author, JO, reviewed the text and suggested some alterations to the discussion and helped to create a comprehensive conclusion to the case. Finally, the fourth author, JSdC, proofread the entire article and helped with the final construction of the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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