title: Bilateral acute retinal necrosis in a patient with multiple sclerosis on natalizumab.
abstract: OBJECTIVE
  The purpose of this study is to report a case of bilateral acute retinal necrosis in a patient with multiple sclerosis treated with natalizumab.
  
  
  METHODS
  This study is a case report and literature review.
  
  
  RESULTS
  A 34-year-old Caucasian female with multiple sclerosis presented with 1 week of blurry vision in both eyes during treatment with natalizumab. Clinical examination revealed bilateral acute retinal necrosis. The patient was treated with systemic intravenous acyclovir and intravitreal injections foscarnet and ganciclovir. Natalizumab therapy was also discontinued.
  
  
  CONCLUSIONS
  Natalizumab is a potent immunosuppressive agent used in relapsing remitting multiple sclerosis and Crohn's disease. The use of this medication is commonly associated with opportunistic infections in the CNS. In rare cases, ocular opportunistic infections may occur and can lead to significant visual impairment and blindness. Neurologists and ophthalmologists should be aware of this potential complication.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, GA, USA. arjunbsood@gmail.com.|Emory Eye Center, Atlanta, GA, USA. arjunbsood@gmail.com.
authors.forename: Arjun B
authors.initials: AB
authors.lastname: Sood
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, GA, USA.|Emory Eye Center, Atlanta, GA, USA.
authors.forename: Gokul
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, GA, USA.|Emory Eye Center, Atlanta, GA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Robinson
keywords: Herpes virus; Immunosuppression; Multiple sclerosis; Natalizumab; Retinal necrosis