OPTIC NEUROMYELITIS AND BILATERAL ACUTE R ETINAL NECROSIS DUE TO VARICELLA-ZOSTER VIRUS IN A PATIENT WITH AIDS

We report a case of bilateral acute retinal necrosis (ARN) following a n acute optic neuromyelitis (AONM) in an immunodepressed patient (T CD 4 lymphocyte count under 50/mm(3)) suffering from acquired immunodefic iency syndrome (AIDS). Despite the medical treatment the evolution led to blindness by bilateral total retinal detachment. The neuro-ophthal mological features occurred prior to the retinal manifestation, and th e acute optic neuromyelitis occurred after a spreading zoster. The var icella-zoster virus (VZV) seemed to be involved because of recurring c utaneous tester, spreading of this zoster just before the AONM, previo us reports showing a link between VZV and AONM, and VZV and ARN. Howev er; our patient had first an AONM responding well to corticosteroid th erapy following one month later by an ARN leading to blindness despite the antiviral treatments received as soon as possible. There is a chr onical viremy in immunodepressed patients with recurring and spreading zoster. The rupture of the hemato-encephalic barrier observed in AONM could facilitate the invasion of the eye by the virus, leading to an ARN. This hypothesis could explain the two complications due to the VZ V, the AONM and the ARN, the first one is of dysimmunitary origin and the second one could probably result of a direct viral attack of the r etina. This should incite to treat as soon as possible each retrobulba r optic neuritis in patients with AIDS, especially if past history of zoster.