Association of acute retinal necrosis with ischemic stroke / Akut retinanekrózis és ischaemiás stroke társulása.

Összefoglaló. A varicella zoster vírus (VZV-) fertozés típusos elso megjelenése a bárányhimlo, késobb a reaktiváció során a herpes zoster. Szemészeti tünet az V/I-es agyideget érinto zoster esetén gyakori. A legrettegettebb szemészeti manifesztáció az akut retinanekrózis, mely fulmináns lefolyású, és súlyos szöveti destrukciót, valamint jelentos funkcionális károsodást, gyakran vakságot hagy maga után. Központi idegrendszeri vascularis érintettség elofordulhat bárányhimlohöz társulóan vagy a késobbi reaktivációk során is, súlyos következményekhez vezetve. A Semmelweis Egyetem Szemészeti Klinikáján akut retinanekrózis tünetével érkezo 65 éves férfi esetét ismertetjük. Az Amerikai Szemorvostársaság (AAO) diagnosztikus kritériumainak mindenben megfelelo klinikai kép alapján azonnal indított adekvát dózisú antivirális kezelés mellett 3 nap múlva, contralateralis hemiparesis hátterében, a képalkotó vizsgálat ipsilateralis ischaemiás stroke-ot igazolt. Intraocularis mintából PCR-vizsgálat bizonyította a vírus jelenlétét. Liquormintában enyhe anti-VZV-IgA-pozitivitás mutatkozott. Az aktuális szemészeti betegség és a stroke társulásának hátterében az észlelt paraméterek, valamint a releváns irodalmi adatok alapján a varicella zoster vírus okozta vasculopathiát valószínusítettük. Gyermekkorban ez az ischaemiás stroke leggyakoribb oka, felnottkorban pedig az V/I-es agyideg herpeses érintettsége esetén négy és félszeres a kockázat stroke kialakulására. A VZV-reaktiváció okozta akut retinanekrózis és a stroke társulásának lehetosége, bár ismert a nemzetközi irodalomban, magyar szakirodalom tudomásunk szerint eddig nem tárgyalta, ez kiemeli esetünk közlésének jelentoségét. Orv Hetil. 2021; 162(48): 1940-1945. Summary. The typical first onset of varicella zoster virus (VZV) infection is chickenpox, later herpes zoster during reactivation. Ophthalmic symptoms are common in herpes zoster affecting the V/I cranial nerve. The most dreaded ophthalmic manifestation is acute retinal necrosis, which has a fulminant course and leaves severe tissue damage as well as significant functional impairment, often blindness. Vascular involvement in the central nervous system may occur in association with chickenpox or during subsequent reactivations leading to severe consequences. We report the case of a 65-year-old male patient with symptoms of acute retinal necrosis at the Department of Ophthalmology, Semmelweis University. The clinical picture fulfilled the diagnostic criteria of the American Academy of Ophthalmology (AAO) and after 3 days of the immediately initiated adequate therapy, contralateral hemiparesis appeared, that was confirmed as an ipsilateral stroke by imaging study. The PCR analysis of an intraocular sample confirmed the presence of VZV. Mild anti-VZV IgA positivity was observed in the cerebrospinal fluid sample. Based on the current ophthalmic disease, the associated stroke alongside with the relevant literature data, varicella zoster vasculopathy was probable. VZV vasculopathy is the most common cause of ischemic stroke in childhood and in adulthood herpetic involvement of the V/I cranial nerve elevates 4.5 times the risk of stroke formation. Though the possible association of acute retinal necrosis and stroke caused by VZV reactivation is known in the international literature, to the best of our knowledge it has not been discussed in Hungary so far, which highlights the importance of reporting our case. Orv Hetil. 2021; 162(48): 1940-1945.

[Placoid chorioretinopathy in systemic infections]. / Placoid chorioretinopathiák szisztémás fertozésekben.

INTRODUCTION AND AIM: To present two cases of placoid chorioretinopathy (ocular syphilis and ocular tuberculosis) and underline the importance of differential diagnosis. METHOD: Two young female patients presented with unilateral loss of vision. Fundus examination showed yellowish placoid lesions in the posterior pole in both cases. RESULTS: Performing fluorescein angiography and laboratory investigations, ocular syphilis was diagnosed in our first case and intraocular tuberculosis was diagnosed in our second case. CONCLUSION: It is important to determine the etiology of the placoid choriaretinopathies due to the different prognosis and therapy and the exclusion of systemic diseases. A comprehensive evaluation of these patients is inevitable for the correct diagnosis and appropriate management. Orv Hetil. 2018; 159(22): 863-869.

[Behcet's disease: a rarely recognized orphan disorder]. / Egy ritkán felismert ritka betegség: a Behcet-kór.

Behcet's disease is a multisystem autoimmune disease with variable clinial manifestations. The diagnosis may pose a difficult challenge for the clinician, who has to be familiar with the wide spectrum and combination of the symptoms of Behcet's disease. It is considered a rare disease in Hungary, and there are only few reports on Behcet's disease in the Hungarian literature. However, the past history of Hungary, the worldwide growing incidence of the disease, and the authors' experience raise the possibility that the occurrence of the disease is higher than previously thought. In this review the authors present and discuss literature data on the pathogenesis and pathomechanism, as well as their own experience concerning the symptomatology of Behcet's disease in order to promote diagnosis and offer adequate therapy for the patients. The authors presume that the importance of the disease is underestimated in Hungary due to a considerable number of unrecognized cases and they propose to establish a national registry for Behcets disease.