ACQUIRED-IMMUNODEFICIENCY-SYNDROME ASSOCIATED-HERPES-SIMPLEX-VIRUS RETINITIS - CLINICAL DESCRIPTION AND USE OF A POLYMERASE CHAIN REACTION-BASED ASSAY AS A DIAGNOSTIC-TOOL

Objectives: To describe 2 patients with acquired immunodeficiency synd rome who experienced a rapidly progressive, bilateral retinitis due to herpes simplex virus (HSV) (1 case due to HSV type 1 [HSV-1] and 1 ca se due to HSV type 2 [HSV-2]) and to present a novel diagnostic polyme rase chain reaction (PCR)-based assay. Methods: The presentation, clin ical course, and diagnostic PCR-based assay used to make the diagnosis of HSV retinitis in 2 patients with acquired immunodeficiency syndrom e are described. Results: Both patients experienced a rapidly progress ive, bilateral retinal necrosis associated with intraretinal hemorrhag es and a diffuse vasculitis. The PCR-based assays demonstrated HSV DNA in the vitreous specimens from the 2 patients. Restriction analysis o n the amplified DNA showed HSV-1 in 1 patient and HSV-2 in the second patient. The diagnosis was supported in both patients by the occurrenc e of a herpes simplex-like encephalitis, and in 1 patient by a positiv e vitreous culture. The HSV-1-associated vasculitis affected primarily the retinal arterioles, with marked capillary dropout and occlusion o f larger arcade vessels. In contrast, the HSV-2-associated vasculitis affected the retinal veins more than the arterioles, and was associate d with an exudative retinal detachment. Conclusions: To our knowledge, these are the first 2 patients with acquired immunodeficiency syndrom e in whom HSV has been implicated as the sole cause of a rapidly progr essing, necrotizing retinitis. Combined PCR and restriction analysis o f vitreous samples from such patients is a useful and highly specific means of diagnosing HSV-1 and HSV-2, retinitis.