ABSTRACT
Thrombotic thrombocytopenic purpura (TTP) is a serious multisystem disorder that is usually rapidly progressive and often fatal if not diagnosed or treated. Unfortunately, the clinical and laboratory features of TTP are not specific and can also be seen in both autoimmune and infectious diseases. We describe a case where the rapid institution of therapy for a TTP-like syndrome masked a culture-negative infectious endocarditis. The diagnosis of this unique patient was established at valvulotomy, necessitated by acute aortic insufficiency.
ABSTRACT
A 31-year-old woman with systemic lupus erythematosus (SLE) developed meningoencephalitis, followed by transverse myelitis. The clinical picture was otherwise not consistent with a lupus flare. Extensive diagnostic evaluation was unrevealing. Acute visual loss ensued, associated with an unusual pattern of retinitis. Endoretinal biopsy established the diagnosis of herpesvirus infection. Reinstitution of antiviral therapy, and optic nerve sheath decompression, led to resolution of neurologic deficits and partial return of vision. Our report is the first that describes a patient with SLE with herpes meningoencephalitis, transverse myelitis, and rapidly progressive outer retinal necrosis, diagnosed antemortem by endoretinal biopsy, and successfully treated with acyclovir and optic nerve fenestration.
Subject(s)
Central Nervous System Diseases/complications , Herpesviridae Infections/complications , Lupus Erythematosus, Systemic/complications , Acyclovir/therapeutic use , Adult , Biopsy , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/therapy , Combined Modality Therapy , Female , Herpesviridae Infections/diagnosis , Herpesviridae Infections/therapy , Humans , Meningoencephalitis/complications , Meningoencephalitis/therapy , Myelitis, Transverse/complications , Myelitis, Transverse/therapy , Opportunistic Infections/complications , Opportunistic Infections/diagnosis , Opportunistic Infections/therapy , Retinitis/complications , Retinitis/diagnosis , Retinitis/therapyABSTRACT
We describe a patient with systemic lupus erythematosus who developed myelopathy, optic neuropathy, retinopathy, and aseptic meningitis unresponsive to immunosuppressive and antimicrobial therapy. Although cultures and brain biopsy were unrevealing, a Herpes virus was suggested by retinal biopsy. The patient recovered dramatically after institution of acyclovir therapy and optic-nerve-sheath decompression. This case demonstrates that herpetic retinitis can occur in an iatrogenically suppressed host and underscores the value of tissue diagnosis.
