A CASE OF UNILATERAL ACUTE RETINAL NECROSIS IN AN IMMUNOCOMPETENT PATIENT

Title A CASE OF UNILATERAL ACUTE RETINAL NECROSIS IN AN IMMUNOCOMPETENT PATIENT
Author, Co-Author Kendra Eck, James Esposito, Nicholas Chan, Deana Lum, George Bertolucci
Topic
Year
2012
Day
Program Number
125697
Room
Exhibit Hall E
Affiliation
VA Central California Health Care System, Fresno Medical Center
Abstract BACKGROUND: Acute retinal necrosis (ARN) is a herpetic necrotizing retinitis most commonly seen in immunocompetent individuals. ARN presents with a panuveitis and confluent areas of peripheral retinal necrosis. Severe retinal thinning and atrophy puts the patient at a high risk for the development of a rhegmatogenous retinal detachment.

CASE REPORT(S): A 79 year old Caucasian male presented to our clinic after seeing an outside ophthalmologist one month prior with the diagnosis of a broken blood vessel in the back of his eye. His chief complaint was increased blurred vision and floaters OD. BCVA was 20/100 with superior temporal constriction on confrontation visual field testing OD. Biomicroscopy revealed 2+ cells in the anterior chamber and moderate vitreous cells and haze OD. Posterior segment examination was remarkable for vasculitis of the superior temporal arcade and peripheral retinitis extending from 8 to 11 o'clock. Lab testing for syphilis, toxoplasmosis, and Lyme disease were ordered along with a lymphocyte panel and chest X-ray. A diagnosis of ARN was suspected given the patient's immunocompetent status and the clinical presentation with significant inflammation. The patient was admitted to the hospital and given IV acyclovir 15mg/kg every eight hours for ten days with excellent response. The patient was later switched to oral valganciclovir as maintenance therapy and continued to improve without further reactivation of the retinitis.

CONCLUSIONS: As with all infectious retinal disease, early recognition and management is essential to reduce the risk of potential devastating vision loss. Differentiating ARN from other types of posterior segment inflammatory conditions based on clinical presentation and immune status is needed for prompt treatment and a more favorable outcome.
Affiliation of Co-Authors VA Central California Health Care System, Fresno Medical Center, VA Central California Health Care System, Fresno Medical Center, VA Central California Health Care System, Fresno Medical Center, VA Central California Health Care System, Fresno Medical Center
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