Acute Retinal Necrosis

A monocular patient with no past ocular history in the left eye presented with several days of decreased vision in the left eye. On examination he was found to have panuveitis, and there was concern for necrotizing retinitis. He was treated empirically for presumed acute retinal necrosis with intravitreal ganciclovir and foscarnet and oral valacyclovir initially, followed by an inpatient admission for intravenous acyclovir. Blood work was sent to rule out other etiologies for uveitis, and an anterior chamber paracentesis was performed. Serology confirmed that the patient was herpes simplex virus (HSV2) IgG positive, and polymerase chain reaction from the aqueous sample confirmed the presence of HSV2. He had recurrent retinitis 6 months after first presentation, requiring re-admission for intravenous acyclovir. Once controlled, his uveitis remained inactive on valacyclovir 1 gram three times per day. However, he developed progressive posterior pole epiretinal membranes. Four years after first presentation, the membranes caused a total tractional retinal detachment. He underwent surgical repair, and at the most recent follow up visit, his retina remained attached under silicone oil and his retinitis remained quiescent.

Presentation Date: 01/27/2022

Issue Date: 02/25/2022