Abstract
BackgroundTo report a case of necrotizing herpetic retinopathy(NHR) in an immuno-compromised pediatric patient.Case presentationAn 11-year-old boy presented with a minimal ocular foreign-body sensation and peripheral visual-field defect, as well as mild upper respiratory symptoms. He had undergone the Fontan operation for a ventricular septal defect and single ventricle during infancy, and had been taking oral steroids for 1 year immediately prior to his presentation to treat protein-losing enteropathy. Initially, a case of either cytomegalovirus (CMV) retinitis or acute retinal necrosis (ARN) was suspected, and an intravenous course of ganciclovir and acyclovir was therefore initiated. During treatment, varicella-zoster virus (VZV) was detected in the anterior chamber, and ARN was confirmed when both serum and aqueous humor were found by polymerase chain reaction (PCR) to be positive for VZV DNA. A peripheral retinal break and detachment developed after medical treatment, and a vitrectomy was performed.ConclusionsTypically, ARN is found in both healthy individuals and subclinically immuno-compromised patients of any age. CMV retinitis is somewhat more typical for immuno-compromised patients. Herein, we report a case of NHR in a pediatric patient with poor general condition and showing minimal signs of inflammation.
Highlights
To report a case of necrotizing herpetic retinopathy(NHR) in an immuno-compromised pediatric patient.Case presentation: An 11-year-old boy presented with a minimal ocular foreign-body sensation and peripheral visual-field defect, as well as mild upper respiratory symptoms
progressive outer retinal necrosis (PORN) is a similar disease entity; it is characterized by necrosis of the retina involving the posterior pole early in the course of disease, and virtually no associated vitreous or anterior chamber inflammation [2]
Several cases of mild acute retinal necrosis (ARN) have been reported that were associated with discrete immune dysfunctions; these had several features of PORN, which is usually seen in more immuno-compromised patients [3]
Summary
Acute retinal necrosis (ARN) is diagnosed clinically using the American Uveitis Society’s criteria for ocular manifestations (1994). The patient had undergone the Fontan operation for a cardiac anomaly, and had been taking oral steroids for 1 year immediately prior to presentation to treat protein-losing enteropathy (PLE) For these reasons, retinitis, caused by either ARN or cytomegalovirus (CMV), was initially suspected, and acyclovir. He had had a mild upper respiratory infection for 2 weeks, but no characteristic skin lesions He had undergone Fontan surgery for ventricular septal defect during infancy, and had been taking oral prednisolone (7.5 mg daily) for protein-losing enteropathy (PLE) for 1 year prior to presentation. By day 3 of therapy, retinal infiltration and hemorrhaging had progressed, and vitreous hemorrhaging and opacity had newly developed in the right eye (Fig. 3) At this time, PCR of an aqueous humor sample was positive for VZV, but negative for HSV-1 and -2, and CMV.
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