title: Progressive outer retinal necrosis: manifestation of human immunodeficiency virus infection.
abstract: We present the case of a 54-year-old man who developed progressive outer retinal necrosis (PORN) as an initial manifestation of HIV infection without any significant risk factors for infection with HIV. PORN is usually found as a manifestation of known AIDS late in the disease. Our patient presented with transient visual loss followed by decrease in visual acuity and facial rash. Subsequent investigation revealed anterior chamber tap positive for varicella zoster virus (VZV), as well as HIV positivity, with an initial CD4 count of 48 cells/µL. Systemic and intravitreal antivirals against VZV, and highly active antiretroviral therapy against HIV were started, which halted further progression of retinal necrosis. This case highlights the importance of suspecting PORN where there is a rapidly progressive retinitis, and also testing the patient for HIV, so appropriate treatment can be started.
authors.affiliation: Eye Ear and Mouth Unit, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
authors.forename: Phey Feng
authors.initials: PF
authors.lastname: Lo
authors.affiliation: Eye Ear and Mouth Unit, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
authors.forename: Rongxuan
authors.initials: R
authors.lastname: Lim
authors.affiliation: Eye Ear and Mouth Unit, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
authors.forename: Serafeim N
authors.initials: SN
authors.lastname: Antonakis
authors.affiliation: Eye Ear and Mouth Unit, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
authors.forename: Goncalo C
authors.initials: GC
authors.lastname: Almeida
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis* / Q000188:drug therapy; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015882:Retinal Necrosis Syndrome, Acute / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D016896:Treatment Outcome; D014822:Vitreous Body / Q000821:virology*
chemical_list: D000998:Antiviral Agents