A 9 Year-Old Girl with Herpes Simplex Virus Type 2 Acute Retinal Necrosis Treated with Intravitreal Foscarnet

Abstract

A 9-year-old girl presented with a 2-week history of redness in the left eye. Examination revealed vitritis, retinal whitening, vasculitis, and optic nerve head edema. Polymerase chain reaction testing of the aqueous fluid revealed herpes simplex virus type 2. The retinitis was controlled with intravenous acyclovir and intravitreal foscarnet. The clinical course was complicated by retinal neovascularization and vitreous hemorrhage, which was treated by pars plana vitrectomy and endolaser. While there are few case reports of herpes simplex virus type 2 retinitis in children, this one is unique for the following reasons: it is the first reported case of herpes simplex virus type 2 retinitis in a child less than 10 years old without a previous history of neonatal infection or central nervous system involvement; no other children have been reported to have been treated with intravitreal foscarnet; and retinal neovascularization complicated the recovery.

Acute Retinal Necrosis Caused by Herpes Simplex Virus Type 2 in Children: Reactivation of an Undiagnosed Latent Neonatal Herpes Infection

“…Another report of acute HSV-2 retinal necrosis occurred in a 9 year old girl from Rochester, NY 4 . She had a 2-week history of redness in the left eye.…”

Emerging concepts in the management of acute retinal necrosis

“…Foscarnet injected intravitreally has been used to treat ARN caused by both HSV and VZV in adults,13 55 in children55 56 and in ARN associated acyclovir-resistant VZV 57 58. Intravitreal foscarnet can be administered at a dose of 2.4 mg/0.1 ml, which requires no dilution from the commercially available intravenous solution, and may be administered immediately following diagnostic sampling of aqueous or vitreous fluid.…”

Acute retinal necrosis (ARN) in the context of neonatal HSV-2 exposure and subconjunctival dexamethasone: case report and literature review

“…This is supported by the number of published cases of HSV-2 ARN with neonatal exposure, twice as many of which have been seen in the last decade, compared to those reported in the 1990s. 3,5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21] Although many documented cases of HSV-2 ARN in the literature have a history of neonatal exposure, some patients do not have such histories and the question of how the infection was acquired remains. 21 Grose 21 proposed that neonatal HSV-2 infections may be contracted perinatally as a subclinical skin, eye, or mouth infection.…”