Herpes Zoster Optic Neuritis in Human Immunodeficiency Virus Infection

Abstract

To the Editor. —Two individuals with presumed herpes zoster optic neuritis associated with human immunodeficiency virus (HIV) infection have been described to date. 1,2 One patient demonstrated improvement of visual acuity following intravenous acyclovir therapy. 1 Neither individual received systemic corticosteroids. We present a third patient with presumed varicella zoster optic neuritis in whom visual acuity rapidly deteriorated to no light perception despite aggressive intravenous acyclovir and corticosteroid treatment. Report of a Case. —A 40-year-old HIV-positive woman developed a vesicular eruption involving the ophthalmic division of the right trigeminal nerve accompanied by several small dendritic corneal lesions and an anterior uveitis of the right eye. Visual acuity was 20/40 OD and 20/20 OS. A diagnosis of herpes zoster ophthalmicus was made, and the patient underwent a 10-day course of intravenous acyclovir (4 g/d). During hospitalization, a thorough infectious evaluation was negative for other opportunistic infections associated with HIV infection, including cytomegalovirus,