Lymphocytic choriomeningitis virus: An underdiagnosed cause of congenital chorioretinitis

PURPOSE: To elucidate the role and clinical spectrum of congenital lymphocy tic choriomeningitis virus infection as a cause of chorioretinopathy, conge nital hydrocephalus, and macrocephaly or microcephaly in the United Stares. METHODS: We performed complete ophthalmologic surveys of all residents at M isericordia, a home for the severely mentally retarded in Chicago, and pros pectively evaluated all patients with chorioretinitis or chorioretinal scar s during a 36-month period at Children's Memorial Hospital, also located in Chicago. Sera for patients demonstrating choriorertinal scars (a sign of i ntrauterine infection) were tested for Toxoplasma gondii, rubella virus, cy tomegalovirus, and herpes simplex virus and lymphocytic choriomeningitis vi rus antibodies. RESULTS: Four of 95 patients examined at the home had chorioretinal scars, and two of these patients had normal T. gondii, rubella virus, cytomegalovi rus, and herpes simplex virus titers and dramatically elevated titers for l ymphocytic choriomeningitis virus. Three of 14 cases of chorioretinitis at the hospital had normal T, gondii, rubella virus, cytomegalovirus, and herp es simplex virus titers and elevated lymphocytic choriomeningitis virus ant ibody titers, (A fourth case, diagnosed in 1996, was reported 2 years ago.) CONCLUSIONS: Lymphocytic choriomeningitis virus was responsible for visual loss in two of four children secondary to chorioretinitis in a population o f severely retarded children. The six new cases of lymphocytic choriomening itis virus chorioretinitis identified in these two populations over the las t 3 years, compared with the total number ever reported in the United State s (10 cases), suggests that lymphocytic choriomeningitis virus may be a mor e common cause of congenital chorioretinitis than previously believed, Beca use its consequences for visual and psychomotor development are devastating , we conclude that the workup for congenital chorioretinitis should include lymphocytic choriomeningitis virus serology, especially if T. gondii, rube lla virus, cytomegalovirus, and herpes simplex virus titers are negative. ( C) 2000 by Elsevier Science Inc. All rights reserved.