gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Diagnostic Pitfalls in a Case of Acute Retinal Necrosis after Herpes Simplex Encephalitis

Meeting Abstract

  • corresponding author H. Baatz - Eye Center Recklinghausen, Department of Ophthalmology, Johann Wolfgan Goethe University Hospital, Frankfurt am Main
  • H.W. Doerr - Institute for Medical Virology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main
  • S. Buxbaum - Institute for Medical Virology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main
  • H.F. Rabenau - Institute for Medical Virology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main
  • W. Preiser - Institute for Medical Virology, Johann Wolfgang Goethe University Hospital, Frankfurt am Main

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 201

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dog2004/04dog692.shtml

Veröffentlicht: 22. September 2004

© 2004 Baatz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Herpes simplex virus (HSV) type-specific antibody tests based on gG antigens have replaced less specific tests in many laboratories.

Methods

We report a patient with acute retinal necrosis of the left eye. Demonstration of HSV DNA in aqueous humour confirmed the diagnosis. Negative results of HSV type-specific antibody tests based on gG antigens suggested a primary HSV infection. However, the patient had a past history of laboratory-confirmed herpes simplex encephalitis six years previously. Using antibody tests based on whole viral lysate antigens he was seropositive from the onset, and immunoblot testing confirmed a lack of anti-gG reactivity.

Results

To be able to assess whether this might be related to the apparent inability of his immune system to suppress clinically symptomatic HSV infection, serial samples were tested by an HSV neutralisation test and a whole-blood flow cytometric assay to determine the frequency of HSV-specific CD4 lymphocytes. However, this did not yield evidence of obvious immunodeficiency.

Conclusions

Although type-specific HSV serological tests based on gG are generally more specific than those based on whole viral lysate antigens, they have a somewhat lower sensitivity. Thus there is a risk of missing individual infected patients. We recommend careful interpretation of negative results when highly specific antibody assays based on recombinant proteins are employed.