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Herpes Zoster Ophthalmicus und Ocular Localization of Chronic Lymphocytic Leukemia (CLL)

1Thimm C., 2von Eicken J., 3Schneider U.,
1Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik (Tübingen)
2Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik, Abt. I (Tübingen)
3Eberhard-Karls-Universität Tübingen, Universitäts-Augenklinik, Abt. III (Tübingen)

Introduction: Neurologic complications in chronic lymphocytic leukemia can be effected directly by the presents of lymphocyts or be caused secondarily by herpetic damage of neural tissue. Both pathomechanisms are discribed for cutaneous but not for ocular lesions.
History: A 78-old man was admitted with a left sided ophtalmoplegia interna and externa and a dramatic loss of vision presenting a zoster ophtalmicus and a B-cell chronic lymphocytic leukemia (Rai IV). The patient was treated with Aciclovir 500 mg iv tds and a tapering course of prednison beginning with 100 mg /day. Ptosis and vision improved from light projection to hand movements. CT and MRI imaging showed an inflammatory lesion of the left optic nerv and infiltrates in the orbital conus surrounding the optic nerv that were most likely of leucemic or herpetic origin. Due to the localisation of findings a biobsy was not done. After reduction of intravenous cortison vision deteriorated although intravenous antiviral therapy was continued. In further progress the ocular infiltrates showed unchanged. In the course of treatment of CLL a chemotherapy with chlorambucil and prednison (Knospe) was initiated that made the infiltrates disappear and improve vision up to 1/35.
Conclusions: So far there are no clinical and radiological criteria about the pathogenetic differeciation of orbital infiltration although it could be of therapeutic importance. Next to herpetic and granulomatous orbital lesions infiltrates of leukemic origin should be taken into account.