Varicella Zoster Acute Retinal Necrosis: A Case Report and Brief Review of the Literature

Abstract

A 50-year-old woman with well controlled hypertension, hyperlipidemia, plaque psoriasis, exercise induced asthma, and migraine headaches presented with a few days of right eye pain. She was diagnosed with a migraine headache and referred to an Optometrist and ultimately to an Ophthalmologist. On examination, she had significant anterior and posterior uveitis, hemorrhagic retinitis, and optic nerve edema in the right eye. An ocular aqueous fluid sample was obtained and sent for polymerase chain reaction (PCR) testing for viral deoxyribonucleic acid (DNA) and came back positive for Varicella Zoster Virus (VZV). The patient was diagnosed with Zoster acute retinal necrosis (ARN) and treated with intravitreal (intraocular) injections of Ganciclovir and Foscarnet as well as intravenous Acylovir and then oral Valacyclovir (Valtrex) as well as oral prednisone. ARN is a rare clinical entity caused most commonly by Herpes Simplex Virus 1 or 2 (HSV 1,2) or Varicella Zoster Virus (VZV) and almost always occurs without typical cutaneous dermatomal manifestations typical of Shingles. Quick identification along with aggressive antiviral and anti-inflammatory treatment can slow progression of this vision threatening disease and reduce risk of blindness and or involvement of the fellow eye.