Korean J Ophthalmol.  2007 Mar;21(1):51-54. 10.3341/kjo.2007.21.1.51.

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

• You YS
• Lee SJ
• Lee SH
• Park CH
• Kwon OW

• KMID: 1105032
• DOI: http://doi.org/10.3341/kjo.2007.21.1.51

Abstract

PURPOSE: 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). METHODS: This study is a case report detailing clinical follow-up and an aqueous humor test by PCR-RFLP. RESULTS: 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. CONCLUSIONS: 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.

Keyword

AIDS; CMV; HSV; PORN; VZV

MeSH Terms

Vitreous Hemorrhage/*complications
Retinitis/*complications/pathology/*virology
Necrosis
Humans
*Herpes Zoster
Female
Disease Progression
Adult
Acquired Immunodeficiency Syndrome/*complications

Figure

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  Fig. 1 Ophthalmoscopic appearance of outer retinitis in the right eye (first visit day). Multifocal deep retinal opacifications and small retinal hemorrhage are visible in the left eye. Some white spots can be seen on the posterior pole of the right eye.

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  Fig. 2 Subsequent fundus photographs of each eye. (A) Extensive deep retinal white opacification sparing perivascular area is visible. Note the retinal and vitreous hemorrhage around optic nerve. These findings are consistent with PORN in the left eye, except for that hemorrhage. Additional inferior retinal and choroidal detachments were found. (B) Multifocal deep retinal lesions are seen with the central macula showing a cherry-red spot in the right eye. This is consistent with PORN.

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  Fig. 3 Subsequent fundus photographs of each eye. (A) Total retinal detachment has occurred. Full-thickness retinal necrosis and vitreous hemorrhage was noted. (B) Inferior retinal and choroidal detachment and subretinal hemorrhage around the optic nerve was noted.

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