Progressive Outer Retinal Necrosis Combined with Vitreous Hemorrhage in a Patient with Acquired Immunodeficiency Syndrome

• Published in: Korean journal of ophthalmology Vol. 21; no. 1; pp. 51 - 54
• Main Authors: You, Yong Sung, Lee, Sung Jin, Lee, Sung Ho, Park, Chang Hyun, Kwon, Oh Woong
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Ophthalmological Society 01.03.2007; 대한안과학회
• Subjects: Acquired Immunodeficiency Syndrome - complications; Adult; Case Report; Disease Progression; Female; Herpes Zoster; Humans; Necrosis; Retinitis - complications; Retinitis - pathology; Retinitis - virology; Vitreous Hemorrhage - complications; 안과학
• ISSN: 1011-8942; 2092-9382
• DOI: 10.3341/kjo.2007.21.1.51

To describe an unusual case of rapidly progressive outer retinal necrosis (PORN) with vitreous hemorrhage in a 41-year-old woman with acquired immunodeficiency syndrome (AIDS), who had retinitis developed from what was probably varicellar-zoster virus combined with cytomegalovirus (CMV) and herpes simplex type 1,2, as proven by the polymerase chain reaction restriction fragment length polymorphism method (PCR-RFLP). This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP. The deep, white retinal lesions coalesced and progressively expanded in a circumferential manner, with sparing of the perivascular retina. However, retinal and vitreous hemorrhages, unusual findings for PORN, could be noted around the optic nerve. Varicellar-zoster virus (VZV), cytomegalovirus (CMV), and herpes simplex types 1,2 (HSV-1,2) were detected in the aqueous humor by PCR. PORN has been described as a variant of necrotizing herpetic retinopathy, occurring particularly in patients with AIDS. Although the etiologic agent has been reported to be VZV, concurrent or combined etiologic agents can include HSV-1, HSV-2, and CMV in AIDS patients. Therefore, combined antiviral therapy with acyclovir and ganciclovir could be more reasonable as an initial therapy.