Central retinal artery occlusion following herpes zoster ophthalmicus and meningitis in a patient with AIDS

Meilin Guan¹, Hongwei Dong¹, Kuifang Du¹*

¹ Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China

Corresprndence:

Kuifang Du; Email: dukuifang1988@126.com

Abstract

Purpose To report an unusual case of central retinal artery occlusion (CRAO) following herpes zoster ophthalmicus, herpes zoster meningitis, and Grade 3 (very high risk) hypertension in a patient with acquired immunodeficiency syndrome (AIDS).

Case presentation A 51-year-old man with AIDS presented with herpes zoster involving the ophthalmic division of the left trigeminal nerve. Clinical findings included severe ptosis, restricted extraocular movements, reduced corneal sensation, anterior uveitis, a dilated pupil with absent light reflex, optic disc hyperemia, and tortuous retinal veins. The patient was febrile and had markedly elevated blood pressure (191/105 mmHg). Cerebrospinal fluid analysis revealed elevated protein levels, pleocytosis, and positive detection of varicella-zoster virus. Two weeks after initiating treatment, the patient developed CRAO in the left eye, and 2 months later, he suffered an acute cerebral stroke.

Conclusion This case highlights an uncommon etiology of CRAO and subsequent stroke in an immunocompromised patient. The sequential vascular events likely resulted from the combined effects of herpes zoster-associated vasculopathy and severe hypertension, suggesting a potential pathogenic link between viral infection and vascular occlusion.

Keywords: central retinal artery occlusion, herpes zoster ophthalmicus, meningitis, hypertension, AIDS