Acute retinal necrosis secondary to multidrug-resistant herpes simplex virus 2 in an immunocompetent adolescent.
OBJECTIVE
To report the clinical course of a patient with acute retinal necrosis resulting from a multidrug-resistant strain of herpes simplex virus 2.


METHODS
Observational case report.


RESULTS
A 17-year-old man with no identifiable immune deficiency presented with pain and decreased vision in his left eye. He had dense anterior and posterior segment inflammation with retinal whitening suggestive of acute retinal necrosis, which progressed despite treatment with intravenous acyclovir, methylprednisolone, and ganciclovir. A transition to intravitreal and intravenous foscarnet led to clinical improvement. Genetic analysis revealed the etiology to be a multidrug-resistant strain of herpes simplex virus 2.


CONCLUSIONS
Antiviral resistance is an uncommon finding among viruses causing acute retinal necrosis in immunocompetent patients. Patients with these infections may be adequately treated with prompt recognition and a change in therapy to alternative antiviral agents such as foscarnet.
*Department of Ophthalmology, California Pacific Medical Center, San Francisco, California; †West Coast Retina Medical Group, San Francisco, California; ‡Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California; and §Department of Vision Science, Berkeley School of Optometry, University of California, Berkeley, California.
Adrian T
AT
Dokey
Sara J
SJ
Haug
H Richard
HR
McDonald
Emmett T
ET
Cunningham
Brandon J
BJ
Lujan
Arthur D
AD
Fu
J Michael
JM
Jumper
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D015828:Eye Infections, Viral / Q000188:drug therapy*; D017245:Foscarnet / Q000627:therapeutic use*; D006561:Herpes Simplex / Q000188:drug therapy*; D018258:Herpesvirus 2, Human / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D015882:Retinal Necrosis Syndrome, Acute / Q000821:virology*; D016896:Treatment Outcome
D000998:Antiviral Agents; D017245:Foscarnet