Unusual Ocular Complication of VZV Reactivation Following Heart Transplant

Abstract

Introduction Acute retinal necrosis manifests as necrotizing retinitis, vitritis, occlusive vasculitis and retinal detachment with loss of vision. It is most commonly caused by Varicella Zoster Virus (VZV), Cytomegalovirus (CMV), Toxoplasmosis, and Herpes Simplex Virus (HSV) and can occur in immunocompetent and immunocompromised individuals. Case Report Our patient is a 63 year old female with a history of end stage ischemic cardiomyopathy who underwent orthotopic heart transplantation. She received thymoglobulin for induction and her first year post-transplant was notable for no episodes of rejection or infection. She was maintained on antiviral prophylaxis with valgancylovir until 7 months post-transplant. By 1 year post-transplant she was maintained on a regimen of Tacrolimus and Mycophenolate Mofetil (MMF). Her Allomap levels were Summary Isolated retinal necrosis due to VZV is a rare but important complication after solid organ transplant. Early recognition and treatment is crucial in preventing permanent vision loss. Adjustment of immunosuppression regimen is key in clearing active infection and preventing transplant rejection. Proactive reduction of immunosuppression should be considered to prevent viral reactivations after 1 year. Post-transplant vaccination against zoster may also be helpful.