Table 1 Timeline of the episodes of care
From: When obstetrics–gynecology specialists need to call an ophthalmologist urgently: a case report
Day 1 | Day 2 | Day 4 | |
|---|---|---|---|
Place | Gynecology ER | General ER | Gynecology ER |
Clinical findings | Vulvar papules and edema, fever 39.5 °C, inguinal adenopathy | Blurred vision, persistent genital lesions, lumbar pain, recurrent fever 39 °C; decreased visual acuity, suspicion of retinal hemorrhages | Painful deep genital ulcerations, dysuria, urinary retention, persistence of blurred vision; patient is concerned about vulvar lesions; has not been to an ophthalmologist yet Fundoscopic examination shows parafoveolar microhemorrhages and whitish lesions of the retina; OCTA: microangiopathy of the retina |
Laboratory results | PCR swabs for HSV of vulvar lesions sent to the laboratory | Leukocytosis 13.9 G/L, CRP 204 mg/L, CSF culture, hemocultures, serologies all normal; PCR swabs of vulvar lesions negative | – |
Suspected diagnosis | HSV-2 primo-infection | Possible side effect of valaciclovir | Inaugural Behçet’s disease |
Decision | Discharged with oral valaciclovir and NSAID | Switch to acyclovir, patient advised to consult an ophthalmologist | Admitted for in-patient stay, urinary catheter, pulsed methylprednisolone 500 mg/day |