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Baylisascaris procyonis and Herpes Simplex Virus 2 Coinfection Presenting as Ocular Larva Migrans with Granuloma Formation in a Child

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  • Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York; Department of Pediatrics, Albert Einstein College of Medicine, New York City, New York; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York; Department of Medicine, Albert Einstein College of Medicine, and Jacobi Medical Center, Bronx, New York; Department of Comparative Pathobiology, Purdue University College of Veterinary Medicine, West Lafayette, Indiana; Virology Laboratory, University of Iowa Children's Hospital, Iowa City, Iowa

Ocular Baylisascaris procyonis infection results from ingestion of infective eggs of B. procyonis, the raccoon ascarid. Herpes simplex virus type 2 (HSV-2) infection of the retina is the result of either primary infection or reactivated disease. Herein, we report a case of a 12-year-old female resident of the Bronx in New York City, who presented with pan-uveitis and vision loss. Initial evaluation for etiologic causes was nondiagnostic. Serology for anti-Baylisascaris procyonis antibodies in serum and vitreous fluid were both positive. Polymerase chain reaction (PCR) of vitreous fluid was positive for HSV-2. Treatment with vitrectomy, albendazole, and acyclovir resulted in mild improvement of visual acuity. The atypical presentation of B. procyonis in this case, as ocular larva migrans with a peripheral granuloma and retinal detachment, underscores the importance of maintaining a high degree of suspicion for this pathogen even in non-diffuse unilateral subacute neuroretinitis (DUSN) patients in urban areas. This case further illustrates that it is possible to have coexisting infections in cases of posterior uveitis.

Author Notes

* Address correspondence to Herbert B. Tanowitz, Department of Pathology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail: herbert.tanowitz@einstein.yu.edu

Financial support: This work was supported in part by NIH Grant AI-89716 (CG).

Authors' addresses: Grace Liu, Pediatric Ophthalmic Consultants, New York, NY, and the Department of Ophthalmology, New York University Langone School of Medicine, New York, NY, E-mail: mailgraceliu@gmail.com. Norman Saffra and Moshe M. Szlechter, Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, NY, E-mails: eyesitemd@gmail.com and moshe.szlechter@nbhn.net. Joanna Dobroszycki, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, E-mail: joanna.dobroszycki@nbhn.net. Glenn Fennelly, Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, E-mail: fennelgl@njsm.rutgers.edu. Kevin R. Kazacos, Department of Comparative Pathobiology, Purdue University, West Lafayette, IN, E-mail: kkazacos@purdue.edu. Charles Grose, University of Iowa Children's Hospital, Iowa City, IA, E-mail: charles-grose@uiowa.edu. Christina M. Coyle and Louis M. Weiss, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, E-mails: christina.coyle@einstein.yu.edu and louis.weiss@einstein.yu.edu. Herbert B. Tanowitz, Department of Pathology, Bronx, NY, E-mail: herbert.tanowitz@einstein.yu.edu.

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