Purpose: To report on two cases of iridocyclitis caused by herpes simplex virus type 2 (HSV-2) in the same eye after a long interval following the resolution of treatment for acute retinal necrosis (ARN).
Case presentation: Case 1: In a 19-year-old male testing revealed 2.5×105 copies/mL of HSV-2 DNA in the aqueous humor of the right eye. The patient was diagnosed with ARN in 2007. Despite systemic administration of acyclovir and corticosteroids for this condition, vitreous opacity worsened. Thereafter, vitrectomy combined with encircling was performed, resulting in resolution of ARN. Ten years after the first medication examination, he visited our hospital again due to blurred vision in his right eye. Examination of the right eye showed inflammation in the anterior segment with no lesion in the fundus, and 6.4×102 copies/mL of HSV-2 DNA were detected in the aqueous humor. Intraocular inflammation subsided on systemic administration of valaciclovir and corticosteroids. Case 2: A 30-year-old female was diagnosed with ARN based on clinical findings, and the detection of HSV-DNA in the aqueous humor of her left eye in a qualitative polymerase chain reaction test in 1995. Fundus lesions were controlled by systemic administration of acyclovir and corticosteroids. Twenty-three years after the first medication examination, she visited our hospital again due to floaters in her left eye. Examination of the left eye revealed inflammation in the anterior segment with no lesion in the fundus, and 7.3×103 copies/mL of HSV-2 DNA were detected in the aqueous humor. Intraocular inflammation subsided with the systemic administration of valaciclovir and corticosteroids.
Conclusions: Although rare, ARN may relapse not only in the fellow eye but also in the same eye following the initial episode. The cause of this condition might be ocular reactivation of HSV infection that has remained latent for a long interval.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 125: 545-552, 2021.
