title: Acute retinal necrosis in childhood.
abstract: BACKGROUND
  Acute retinal necrosis (ARN) is a viral syndrome consisting of uveitis/vitritis, occlusive vasculitis and peripheral necrosis. Few incidents are reported in children. The etiology is reactivated herpes simplex virus (HSV) or varicella-zoster virus (VZV). Treatment with acyclovir is often used. The administration of oral glucocorticosteroids is of unproven benefit. Prognosis is variable but poor.
  
  
  METHODS
  Three weeks after contracting mild chickenpox, a healthy 4-year-old girl developed blurred vision in her right eye. Severely reduced visual acuity was noted, together with anterior uveitis, 'mutton-fat' precipitates and vitral flare. Retinal vasculitis with necrosis was present. Serology for toxoplasma, cytomegalovirus and HIV was negative, while HSV and VZV IgG antibodies were positive. She was treated with 30 mg/kg of intravenous methylprednisolone (3 days), 30 mg of oral prednisone (3 days), and tapering for 8 weeks. Intravenous acyclovir was given for 10 days, followed by oral acyclovir for 4 months. Aspirin (100 mg/day) was given for 4 months.
  
  
  RESULTS
  At 12 months, the girl felt good. Her right eye acuity was 6/9, with an intraocular pressure of 17 mm Hg. The peripheral retina showed scarring but no detachment.
  
  
  CONCLUSIONS
  This is the first report of a once-daily high-dose methylprednisolone pulse therapy in one of the youngest known ARN cases. Pulsed steroid therapy was based on its known effectiveness in vasculitis, which is the main pathophysiology in ARN. There was no evidence of steroid-related viral over-replication. Our case achieved an excellent clinical and ophthalmic recovery in spite of the poor prognosis. The positive result of this case report provides a basis for further evaluation of high-dose steroid pulse therapy in ARN.
authors.affiliation: Tzameret Medical Track, Hebrew University, Jerusalem, Israel ; Department of Ophthalmology, Ziv Medical Center, Safed, Israel ; Faculty of Medicine, Bar Ilan University, Safed, Israel.
authors.forename: Yoav Y
authors.initials: YY
authors.lastname: Pikkel
authors.affiliation: Tzameret Medical Track, Hebrew University, Jerusalem, Israel ; Department of Ophthalmology, Ziv Medical Center, Safed, Israel ; Faculty of Medicine, Bar Ilan University, Safed, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pikkel
keywords: Children; Methylprednisolone; Retinal necrosis