Progressive outer retinal necrosis combined with vitreous hemorrhage in a patient with acquired immunodeficiency syndrome.
OBJECTIVE
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.
You
Yong Sung
YS
NUNE Eye Hospital, Seoul, Korea.
Lee
Sung Jin
SJ
Lee
Sung Ho
SH
Park
Chang Hyun
CH
Kwon
Oh Woong
OW
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D018450:Disease Progression; D005260:Female; D006562:Herpes Zoster; D006801:Humans; D009336:Necrosis; D012173:Retinitis / Q000150:complications* / Q000473:pathology / Q000821:virology*; D014823:Vitreous Hemorrhage / Q000150:complications*