Acute retinal necrosis in primary herpes simple type I infection

PURPOSE: to report the case of an immunocompetent child who developed severe ocular involvement in primary herpes simplex virus type I (HSV-I) infection. METHOD: (case report) an 8 year-old, HIV-negative child, was referred with ocular redness in his right eye preceded by influenza-like symptoms one week before. RESULTS: first examination revealed poor visual acuity, optic neuritis and peripheral exudative/haemorrhagic retinitis. He tested negative for herpes simplex type I and II. Three days later a granulomatous inflammation of the anterior chamber of the eye developed. Three consecutive serologies revealed a rising of IgM antibody titer in the serum to HSV type 1 (IgG antibody was still negative). Ocular herpes type I infection was confirmed by an anterior chamber tap by a positive polymerase chain reaction analysis of the aqueous humor. Visual acuity did not recover in spite of high dose of intravenous acyclovir therapy. CONCLUSION: presentation concerns a case of ARN syndrome in a child not previously immunized to HSV-1. Ocular inflammation appeared and increased along with the presence in the serum of specific antibody. The immune response of the host may significantly modulate the clinical aspect of an acute herpetic ocular infection. Central nervous system involvement in primary herpetic infection is an extremely rare complication. This child presented a primary acute retinal necrosis syndrome within 7 days following a primary herpes simplex type I infection.