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Published Date: 2018-04-18 11:32:19
Subject: PRO/EDR> Varicella update (08): UK (England) necrotizing retinitis
Archive Number: 20180418.5754188
A ProMED-mail post
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International Society for Infectious Diseases

Date: Thu 12 Apr 2018
Source: Association of Optometrists (AOP)/Optometry Today [edited]

[ref: Yu J, Ashworth J, Hughes S, Jones N. Varicella-zoster virus necrotising retinitis, retinal vasculitis and panuveitis following uncomplicated chickenpox in an immunocompetent child. BMJ Case Rep. 2018. pii: bcr-2017-223823. doi: 10.1136/bcr-2017-223823; abstract available at http://casereports.bmj.com/content/2018/bcr-2017-223823.abstract

A 4-year-old presented to Manchester Royal Eye Hospital with acute visual loss in her left eye after an uneventful episode of chickenpox.

Clinicians have described what they believe is only the 4th reported case of retinitis in a child following infection with chickenpox.

Writing in BMJ Case Reports [see reference above], Manchester Royal Eye Hospital clinicians highlight that the case of a 4-year-old girl who presented with visual loss and redness in her left eye is a reminder that the varicella-zoster virus can cause occlusive retinal vasculitis.

"Necrotising retinitis is rare in children but typically presents with acute painful unilateral visual loss," they explain.

The authors describe how the child had a 4-day history of blurred vision in her left eye when she was referred to the hospital uveitis clinic.

Four weeks previously she had mild chickenpox, which had settled, and was otherwise well.

She received combined intravenous and intravitreal antiviral treatment, leading to "rapid improvement" with settled retinitis, no vascular occlusion, and good recovery of vision.

"This case of varicella-zoster virus necrotising retinitis with panuveitis in a 4-year-old child highlights the importance of careful fundal examination in childhood uveitis, the need for urgent high-dose antiviral treatment and a multidisciplinary approach," the authors emphasise.

Without treatment, complications of the condition can include retinal detachment, optic atrophy, contralateral eye involvement, and meningoencephalitis.

[Byline: Selina Powell]

Communicated by:
ProMED-mail from HealthMap Alerts

[It is noted in the BMJ publication on this rare case, that the child's recent coinfection with Epstein-Barr virus may have acted to provoke the retinitis. Besides varicella zoster virus (VZV), the inflammation can also be due to certain herpes viruses, herpes simplex virus (HSV-1 and HSV-2), and Epstein-Barr Virus (EBV). - Mod.LK

HealthMap/ProMED-mail map
Manchester, England, United Kingdom: http://healthmap.org/promed/p/1061]

See Also

Varicella update (07): Mexico (YU) vaccination sequelae 20180410.5736721
Varicella update (06): Australia (NS), USA (LA), South America (Venezuela) 20180331.5720582
Varicella update (05): USA (IL) India (OR) 20180320.5699550
Varicella update (04): South Asia (Sri Lanka) university closure 20180315.5687588
Varicella update (03): shingles research, India alert 20180222.5645052
Varicella update (02): USA (NY) background 20180207.5612848
Varicella update (01): USA (NY) 20180204.5606488
Varicella update (02): India, USA (MN) 20171214.5503292

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