gms | German Medical Science

Up to our best knowledge, until now an acute bilateral panuveitis caused by HSV-2 has never been described. Some case reports indicate that HSV-1 can be responsible for monolateral or bilateral acute retinal necrosis. The herpes simplex virus type 2 is normally sexually transmitted and may infect the meninges leading to the syndrome of viral meningitis or may even advance to a meningoencephalitis with benign course, while HSV-1 is more likely to cause meningoencephalitis with serious brain dysfunction.

Case report with clinical, histopathological and infectional diagnostic findings.

Two weeks after excision of a suprasellar epidermoid cyste and systemic steroidtherapy (dexamethasone 20mg/day) a 34-year-old woman complained about retrobulbar pain associated with reduction of visual function on both eyes. The patient suffered a sterile meningitis six years ago. (There were two travels abroad, to Thailand and Yugoslawia). The clinical examination presented bilateral iridocyclitis with posterior synechia in the left eye and massive cellular infiltration of the vitreous accompanied by multiple subretinal infiltrations of different size. There were no clinical signs of acute retinal necrosis. In the vitrectomy material we could identify HSV-2 by PCR. The cerebrospinal fluid indicated an aseptic meningitis and the presence of HSV-2 infection.(In the meantime the patient told us about a redness with some small vesicles in the inguinal region.) Immediately after the identification of HSV-2, intravenous therapy with Zovirax (1800mg/day ) and corticosteroids (100mg/day) was initiated. The panuveitis responded well to the treatment, however to date, the visual function of the eyes recovered only partially.

Acute bilateral panuveitis with chrorioretinal infiltration especially after surgery or high dose corticosteroid therapy one should consider an infection of HSV-2. A fast diagnosis is of paramount importance, because the patient is endangered by the local and systemical progression of the HSV-2 infection, which could possibily lead to a meningoencephalitis.