Varicella zoster virus (VZV) acute retinal necrosis (ARN)

A. Color retinography (Clarus 500, Carl Zeiss Meditec ASG, Jena, Germany) of the right eye showing vitritis and multiple whitish lesions, some of them confluent, predominantly in the periphery, due to opacification of the inner retina due to ischemic necrosis induced by reactivation of the varicella zoster virus.

B. Macular optical coherence tomography (Cirrus 5000, Carl Zeiss Meditec ASG, Jena, Germany) on two of these lesions, showing increased inner retinal refraction secondary to ischemia, as well as thinning of retinal thickness in one of the lesions.

Description

Acute retinal necrosis syndrome (ARN) is a rare condition characterized by necrotizing vaso-occlusive retinitis, retinal arteritis, vitritis, and often with subsequent development of rhegmatogenous retinal detachment. It is usually caused by reactivation of viruses from the herpes group (mainly VZV and herpes simplex viruses 1 and 2), and affects both healthy and immunocompromised patients.

Comments

Without adequate treatment, approximately 1/3 of patients may develop bilateral involvement, usually within 6 weeks to 4 months of the onset of symptoms in the first eye. Etiological treatment consists of antiviral drugs administered systemically (orally or IV) and intravitreally. Once etiological treatment has been started, systemic corticosteroid therapy may be required to reduce the deleterious effects of the immune response to the virus. However, local use of depot corticosteroids should be avoided due to the risk of worsening the pathology.

Indication

A 58-year-old woman with humoral immunodeficiency secondary to treatment with ant-CD20 and a history of severe right ophthalmic herpes zoster 10 years ago presents an episode of right panuveitis with multifocal VZV retinitis.