Necrotizing herpetic retinopathy in an immune-compromised pediatric patient with minimal signs of inflammation: case report.
BACKGROUND
To report a case of necrotizing herpetic retinopathy(NHR) in an immuno-compromised pediatric patient.


METHODS
An 11-year-old boy presented with a minimal ocular foreign-body sensation and peripheral visual-field defect, as well as mild upper respiratory symptoms. He had undergone the Fontan operation for a ventricular septal defect and single ventricle during infancy, and had been taking oral steroids for 1 year immediately prior to his presentation to treat protein-losing enteropathy. Initially, a case of either cytomegalovirus (CMV) retinitis or acute retinal necrosis (ARN) was suspected, and an intravenous course of ganciclovir and acyclovir was therefore initiated. During treatment, varicella-zoster virus (VZV) was detected in the anterior chamber, and ARN was confirmed when both serum and aqueous humor were found by polymerase chain reaction (PCR) to be positive for VZV DNA. A peripheral retinal break and detachment developed after medical treatment, and a vitrectomy was performed.


CONCLUSIONS
Typically, ARN is found in both healthy individuals and subclinically immuno-compromised patients of any age. CMV retinitis is somewhat more typical for immuno-compromised patients. Herein, we report a case of NHR in a pediatric patient with poor general condition and showing minimal signs of inflammation.
Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, #327 Sosa-ro, Wonmi-gu, Bucheon, 420-717, Korea.
Soon Il
SI
Choi
Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, #327 Sosa-ro, Wonmi-gu, Bucheon, 420-717, Korea.
Jae Ryun
JR
Kim
Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Bucheon St. Mary's Hospital, #327 Sosa-ro, Wonmi-gu, Bucheon, 420-717, Korea. raho@catholic.ac.kr.
Ho
H
Ra
D002648:Child; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D014786:Vision Disorders / Q000821:virology*
Acute retinal necrosis; Necrotizing herpetic retinopathy