Remdesivir Lowered Anti-Measles IgG Antibody Level in the Cerebrospinal Fluid but Did Not Arrest Measles-Induced Macular Necrotizing Retinitis
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Yes
Purpose
Subacute sclerosing panencephalitis (SSPE) is a fatally progressive neurodegenerative disorder caused by persistent latent measles wild virion. We aim to report the visual and clinical outcomes of necrotizing retinitis, three decades after suffering from measles- induced pneumonia.
Methods
Descriptive case report.
Results
A 31-year-old healthy woman presented with sudden painless blurred vision of the right eye (RE). Visual acuity (VA) was finger counting in RE. Funduscopy revealed RE multifocal macular yellowish lesions, LE peripheral retinal atrophic scar and bilateral optic disc edema. OCT of RE showed “moth-eaten” macula. Elevated anti-measles IgG and positive oligoclonal bands were detected in cerebrospinal fluid (CSF). Aqueous PCR was positive for measles. Brain MRI showed nonspecific FLAIR hyperintense foci in the supratentorial periventricular and subcortical white matter. Electroencephalogram revealed notable irregularities, specifically characterized by left temporal focal slowing down. Remdesivir, intravenous immunoglobulin and intrathecal interferon-ɑ were instituted. Macular necrosis progressed relentlessly. Remdesivir lowered anti-measles IgG titer in CSF and serum and it re-increased once remdesivir was discontinued.
Conclusion
Remdesivir has a broad antiviral spectrum. Its use in combination with IVIG and intrathecal interferon-ɑ failed to arrest meales-associated macular necrosis. In the absence of a known cure, vaccination remains the most effective modality. Further investigation of remdesivir as a potential treatment of SSPE is required.
Conflict of interest
No
1
Last name
ABU AL-HALAWA
Initials of first name(s)
D
Department
Ophthalmology
City
Jerusalem
Country
Israel
2
Last name
GEBARA
Initials of first name(s)
A
Department
Ophthalmology
City
Jerusalem
Country
Israel
3
Last name
AMER
Initials of first name(s)
R
Department
Ophthalmology
City
Jerusalem
Country
Israel
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