Bilateral acute retinal necrosis after herpetic meningitis

Keisho Hirota^1,2, Masayuki Akimoto^1,3, Toshiaki Katsura<sup>2

1</sup>Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, ²Internal Medicine, Kyoto Medical Center, ³Clinical Research Center, Kyoto Medical Center, Kyoto, Japan

Purpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.
Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.
Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.

Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus