Giovanna Baldarrag, MD

Bilateral retrobulbar optic neuritis developed in a 38-year-old woman with advanced HIV infection. This was secondary to varicella-zoster virus (VZV) infection, confirmed by polymerase chain reaction detection of VZV in the patient's cerebrospinal fluid. There was no evidence of retinitis, and the ocular symptoms preceded the rash. This case illustrates that a new onset of unexplained visual loss resulting from optic neuritis in an HIV-positive patient may be caused by VZV infection. Clinicians should be aware of this unusual manifestation of VZV infection. Prompt recognition and early intervention with antivirals are needed, but it is unclear how much vision can be preserved.