RESUMO
Progressive outer retinal necrosis syndrome (PORN) is a severe clinical variant of necrotizing herpetic chorioretinitis, which occurs almost exclusively in patients with advanced acquired immunodeficiency syndrome (AIDS). To date, only a few cases of PORN have been reported in patients, mostly among those who were immunocompromised. To our knowledge, only one case of PORN in a patient with systemic lupus erythematosus (SLE) has been described. We report the case of a 44-year old HIV-negative patient with lupus nephritis, whom was being treated by mycophenolate mophetil (MMF), arechin and prednisone. After 14 months of MMF therapy, the patient revealed PORN symptoms; and several months later, the patient developed Type B primary central nervous system lymphoma (PCNSL). PORN is usually compared to acute retinal necrosis (ARN) syndrome, because of having the same causative agent: varicella zoster virus (VZV). There are also some similarities in clinical findings. Our observation supports the hypothesis that PORN symptoms in HIV-negative patients can be an intermediate form between ARN and PORN, and can vary according to the patient's immune status.
Assuntos
Coriorretinite/virologia , Herpes Zoster/complicações , Lúpus Eritematoso Sistêmico/complicações , Adulto , Antivirais/uso terapêutico , Neoplasias do Sistema Nervoso Central/complicações , Cloroquina/análogos & derivados , Cloroquina/uso terapêutico , Coriorretinite/etiologia , Evolução Fatal , Feminino , Soronegatividade para HIV , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Linfoma/complicações , Imageamento por Ressonância Magnética , Ácido Micofenólico/uso terapêutico , Prednisona/uso terapêutico , Síndrome de Necrose Retiniana Aguda , Acuidade VisualRESUMO
Ocular complications in patients who underwent renal transplantation are attributed to side effects of the immunosuppressive regimen. Progressive outer retinal necrosis (PORN) syndrome is a clinical variant of necrotizing herpetic retinopathy and it occurs almost exclusively in patients with acquired immunodeficiency syndrome. We present a case of a human immunodeficiency virus-negative patient who underwent renal transplant and, after a few years, developed bilateral PORN associated with viral infections. Varicella zoster virus (VZV) and BK virus were identified by polymerase chain reaction from the vitreous fluid. It is unclear which of the viruses identified had the dominant role in the pathogenesis of PORN and other organ damage, or whether their actions were synergistic. Adequate antiviral immune surveillance, as well as pre-transplant vaccination against VZV, may reduce the incidence of VZV infection and its complications.