Progressive outer retinal necrosis caused by herpes simplex virus type 1 in a patient with acquired immunodeficiency syndrome

Objective/Background: To identify the etiologic agent of rapidly progressiv e outer retinal necrosis (PORN) in a 32- year-old man with acquired immunod eficiency syndrome (AIDS), who had retinitis developed from cytomegalovirus (CMV). Multiple yellowish spots appeared in the deep retina without eviden ce of intraocular inflammation or retinal vasculitis, diagnosed clinically as PORN. Death occurred after failure of multiple organs. Design: Case report. Methods: Both globes were taken at autopsy, fixed in formalin, and examined histopathologically and immunohistochemically to identify causative agents in the retinal lesions. Main Outcome Measure: Immunohistochemistry. Results: All layers of the retina were severely damaged and contained focal calcification. Cytomegalic inclusion bodies were found in cells in the dam aged retina of the right eye. Immunohistochemical studies for herpesviruses revealed the presence of CMV antigens in the right retina at the posterior pole and herpes simplex virus type 1 (HSV-1)-specific antigen in the perip hery of both retinas. No varicella-zoster virus (VZV) antigen was detected in either retina. Conclusions: PORN has been described as a variant of necrotizing herpetic r etinopathy, occurring particularly in patients with AIDS. Although the etio logic agent has been reported to be VZV, HSV-1 can be an etiologic agent. ( C) 2000 by the American Academy of Ophthalmology.