Chorioretinitis Associated with HSV-1 Neuroinfection Following Viral Infection. A Case Report

Overview

Introduction: Chorioretinitis is an inflammatory disorder affecting the choroid and the retina, classified among posterior uveitis conditions. It is clinically manifested in central visual impairment, visual field defects, and in more severe cases may lead to irreversible loss of vision. Accurate differentiation between infectious and non-infectious etiologies is essential, as treatment strategies differ significantly. The prognosis depends on early diagnosis and timely initiation of targeted therapy.

Purpose: To present a case of a rare form of chorioretinitis associated with HSV-1 reactivation following a recent parvovirus B19 infection.

Case presentation: A 35-year-old female patient reported to our center in June 2024 with acute deterioration of vision in her left eye. Her medical history revealed that approximately 10 days prior to the examination, the patient had suffered a viral illness with exanthematous manifestations, diagnosed as parvovirus B19 infection, which was managed symptomatically. A fundoscopic examination revealed inflammatory changes in the macular region. As part of differential diagnostics, fluorescein angiography, OCT, perimetry, serological testing and lumbar puncture were performed. A molecular analysis of cerebrospinal fluid confirmed HSV-1 by PCR. Antiviral treatment with acyclovir (750 mg i.v. every 8 hours, followed by 400 mg orally twice daily for 6 weeks) led to clinical stabilization and improvement of central visual acuity to 20/25.

Conclusion: The presumed association between parvovirus B19 infection and subsequent HSV-1 reactivation indicates a potential immunomodulatory effect. This case underscores the importance of a multidisciplinary approach and prompt therapeutic intervention in the case of viral neuro-ophthalmic complications.