Herpes zoster ophthalmicus, more than meets the eye – Asceptic meningitis and optic perineuritis related to herpes zoster virus reactivation

We report a case of herpes zoster ophthalmicus associated with an aseptic meningitis with optic perineuritis, both unusual complications of the reactivation of the Varicella-Zoster virus (VZV). A 23-year-old male living with HIV went to our clinic after a 1-week period of herpes zoster in the region of the right ophthalmic nerve, referring painless vision loss of the right eye (OD). At the initial evaluation, the visual acuity of the right eye was no light perception. The OD slit-lamp examination was remarkable for optic nerve head edema, peripapillary hemorrhages, and pale discoloration of the macula. After 1 week of systemic antiviral therapy, there was complete resolution of the optic disc edema; unfortunately, the vision remained unchanged due to the retinal ischemia. This case highlights the relevance of an adequate multidisciplinary approach and timely treatment of the VZV reactivation in people living with HIV despite viral load or CD4 count.