Wegener's granulomatosis, pituitary adenoma and BARN

A 53-year-old man with Wegener's granulomatosis and a co-existing pituitary adenoma developed bilateral acute retinal necrosis (BARN), probably secondary to varicella-zoster virus (VZV) infection as IgM antibodies were detected in the serum. Intravenous acyclovir and ganciclovir limited the spread of necrosis, but to prevent recurrence he was maintained on oral acyclovir. A left cataract developed 17 months later which was extracted and replaced with a heparin surface modified intraocular lens. Intraocular specimens removed at the time of surgery were analysed by the polymerase chain reaction (PCR) using primers specific for a number of the herpes group of viruses, but no herpesviral DNA could be detected.