23312850 Visualization

A 54 Age year Age - old Age diabetic History woman Sex complained of blurred Sign_symptom vision Sign_symptom in the left Biological_structure eye Biological_structure for 5 Duration days Duration without scalp Biological_structure tenderness Sign_symptom or headache Sign_symptom .
Visual Diagnostic_procedure acuity Diagnostic_procedure ( VA Diagnostic_procedure ) was 20/20 Lab_value right Biological_structure eye Biological_structure and 20/30 Lab_value left Biological_structure eye Biological_structure .
Intraocular Diagnostic_procedure pressures Diagnostic_procedure were normal Lab_value .
Funduscopic Diagnostic_procedure examination Diagnostic_procedure revealed left Biological_structure optic Biological_structure nerve Biological_structure edema Sign_symptom and a small Severity disc Biological_structure margin Biological_structure hemorrhage Sign_symptom .
WBC Diagnostic_procedure count Diagnostic_procedure was 12,700 Lab_value , ESR Diagnostic_procedure was 7 Lab_value (normal 0–20 mm/hr) and CRP Diagnostic_procedure was 2.4 Lab_value (normal 0–1.0 mg/dL).
Three Date days Date later Date , she noted new left Biological_structure eye Biological_structure pain Sign_symptom and her vision Diagnostic_procedure declined to counting Lab_value fingers Lab_value .
There was no pain Sign_symptom on Detailed_description eye Detailed_description movement Detailed_description .
The right Diagnostic_procedure pupil Diagnostic_procedure was 4 Distance mm Distance and reacted Lab_value to Lab_value light Lab_value ; the left Diagnostic_procedure pupil Diagnostic_procedure was 4 Distance mm Distance , and there was a relative Detailed_description left Biological_structure afferent Biological_structure pupillary Biological_structure defect Sign_symptom .
The left Biological_structure optic Biological_structure nerve Biological_structure was swollen Sign_symptom with a few Detailed_description peripapillary Biological_structure nerve Biological_structure fiber Biological_structure layer Biological_structure hemorrhages Sign_symptom along with a cherry Color red Color spot Sign_symptom and mild Severity macular Biological_structure edema Sign_symptom consistent with central Disease_disorder retinal Disease_disorder artery Disease_disorder occlusion Disease_disorder ; there were no posterior Biological_structure pole Biological_structure or peripheral Biological_structure retinal Biological_structure hemorrhages Sign_symptom .
Trace Diagnostic_procedure cells Diagnostic_procedure were seen Lab_value in the anterior Biological_structure chamber Biological_structure , but not Lab_value in the vitreous Biological_structure fluid Biological_structure .
Repeat WBC Diagnostic_procedure , ESR Diagnostic_procedure and CRP Diagnostic_procedure were normal Lab_value .
Treponemal Detailed_description and Bartonella Detailed_description antibodies Diagnostic_procedure , the QuantiFERON Diagnostic_procedure - TB Diagnostic_procedure test Diagnostic_procedure , blood Diagnostic_procedure cultures Diagnostic_procedure , EKG Diagnostic_procedure and carotid Biological_structure Doppler Detailed_description ultrasound Diagnostic_procedure were unremarkable Lab_value .
Brain Biological_structure contrast Detailed_description MRI Diagnostic_procedure demonstrated no Lab_value optic Biological_structure nerve Biological_structure enhancement.
Twelve Date days Date later Date , left Biological_structure eye Biological_structure pain Sign_symptom and vision Diagnostic_procedure worsened Lab_value , and the patient complained of jaw Biological_structure claudication Sign_symptom and scalp Biological_structure pain Sign_symptom .
VA Diagnostic_procedure declined to no Lab_value light Lab_value perception Lab_value in the left Biological_structure eye Biological_structure with 1+ Lab_value cells Diagnostic_procedure and Diagnostic_procedure flare Diagnostic_procedure in anterior Biological_structure chamber Biological_structure and 2+ Lab_value vitreous Diagnostic_procedure cells Diagnostic_procedure and Diagnostic_procedure haze Diagnostic_procedure .
Funduscopic Diagnostic_procedure examination Diagnostic_procedure revealed extensive Severity retinal Biological_structure necrosis Sign_symptom and diffuse Detailed_description hemorrhages Sign_symptom with multiple Detailed_description areas Detailed_description of focal Detailed_description venous Sign_symptom beading Sign_symptom (Fig.1), consistent with acute Disease_disorder retinal Disease_disorder necrosis Disease_disorder .
Vitreous Biological_structure fluid Biological_structure was examined by PCR Diagnostic_procedure for amplifiable HSV Diagnostic_procedure , VZV Diagnostic_procedure , CMV Diagnostic_procedure and toxoplasma Diagnostic_procedure sequences and returned positive Lab_value for VZV Diagnostic_procedure DNA Detailed_description .
She was treated with a one Frequency - time Frequency intravitreal Administration injection Administration of ganciclovir Medication 2000 Dosage mcg/0.5 Dosage ml Dosage in the left Biological_structure eye Biological_structure , oral Administration acyclovir Medication 800 Dosage mg Dosage 5 Dosage times Dosage daily Dosage for 14 Duration days Duration and oral Administration prednisone Medication 60 Dosage mg Dosage daily Dosage for 7 Duration days Duration followed by 20 Dosage mg Dosage for 7 Duration days Duration .
Eleven Date days Date after Date starting treatment, because she had recently developed jaw Biological_structure claudication Sign_symptom and intermittent Frequency scalp Biological_structure pain Sign_symptom , a temporal Biological_structure artery Biological_structure biopsy Diagnostic_procedure was performed.
Histological Diagnostic_procedure examination Diagnostic_procedure was normal Lab_value (Fig.2) while immunohistochemical Diagnostic_procedure analysis Diagnostic_procedure demonstrated Lab_value VZV Diagnostic_procedure antigen Diagnostic_procedure in the arterial Biological_structure adventitia Biological_structure ; evaluation of adjacent sections for HSV-1 antigen Diagnostic_procedure and infiltrating Diagnostic_procedure leukocytes Diagnostic_procedure (CD45, not shown) was negative Lab_value (Fig.3).
Antiviral therapy was altered to intravenous Administration acyclovir Medication , 10 Dosage mg/kg Dosage every Dosage 8 Dosage h Dosage for 14 Duration days Duration , and steroids Medication were discontinued.