Two patients with the von Szily reaction: herpetic keratitis and contralateral retinal necrosis.

Abstract

PURPOSE:

To present two patients with prior unilateral, herpetic keratitis who developed acute retinal necrosis (ARN) in the contralateral eye. These cases have noticeable similarities to the von Szily reaction. This describes the development of a contralateral retinitis subsequent to an anterior chamber injection of herpes simplex virus (HSV).

DESIGN:

Interventional case series.

METHODS:

Retrospective chart and literature review.

RESULTS:

The first patient had neonatally acquired herpetic keratitis and developed ARN at age 21. Polymerase chain reaction of a vitreous biopsy detected HSV type-2 (HSV-2). The second patient was clinically diagnosed with ARN contralateral to varicella zoster keratitis. A detailed literature search located seven prior case reports with a von Szily reaction. These resembled our two cases except none had HSV-2 or years of latency from keratitis to retinitis.

CONCLUSIONS:

Clinicians need to be cognizant of the von Szily reaction.

• Authors: Lynnelle K Smith, Paul A Kurz, David J Wilson, Christina J Flaxel, James T Rosenbaum
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 143 Issue 3 Pg. 536-8 (Mar 2007) ISSN: 0002-9394 [Print] United States
• PMID: 17317412 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Glucocorticoids
• Timolol
• Cyclopentolate

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Cyclopentolate (therapeutic use)
• Drug Therapy, Combination
• Female
• Glucocorticoids (therapeutic use)
• Herpesvirus 2, Human (genetics, isolation & purification)
• Herpesvirus 3, Human (genetics, isolation & purification)
• Humans
• Keratitis, Herpetic (complications, diagnosis, drug therapy)
• Male
• Polymerase Chain Reaction
• Retinal Necrosis Syndrome, Acute (diagnosis, drug therapy, etiology)
• Retrospective Studies
• Timolol (therapeutic use)
• Vitreous Body (virology)