Necrotizing retinitis of multifactorial etiology

Abstract

Introduction. We present the case of a 73-year-old woman with osteoporosis, who presented to the emergency room with a sudden vision loss and ocular pain in the right eye, which appeared two days before. The patient mentioned loss of appetite, weight loss for three months and low fever for two weeks. Materials and methods. Among the ophthalmological findings, the most important were panuveitis, and large confluent necrotic areas in the peripheral retina. The patient was diagnosed with RE Panuveitis and acute necrotizing retinitis. Results. Blood exams showed leukocytosis and monocytosis, thrombocytosis and anemia. Further investigations showed high levels of Cytomegalovirus (CMV) anti IgG and Herpes Simplex (HS) type 1 virus anti IgM, urinary infection, and secondary hepatic cytolysis. The CT and MRI of the thorax and abdomen showed no sign of neoplastic disease, and no explanation for the CMV infection was found. The patient received general corticotherapy and antiviral therapy, and, after one month, RE BCVA was 20/ 30. Particularity of the case. Acute necrotizing retinitis in an old patient with CMV and HSV type 1, associated with secondary hepatic cytolysis, without any other immunosuppressive disease and very good outcome.

Keywords: Cytomegalovirus; Herpes Simplex Type 1; acute necrotizing retinitis; corticotherapy; panuveitis; vasculitis.

Fig. 1

Eye fundus (RE) - vitritis

Fig. 2

Eye fundus (RE) – large confluent areas of retinal necrosis, narrowed vessels

Fig. 3

RE - narrowed vessels, peripheral retinal hemorrhage

Fig. 4

Peripheral retinal necrosis (RE)

Fig. 5

LE Fundus - within normal limits

Fig. 6

Eye fundus aspect of the RE

Fig. 7

RE eye fundus peripheral aspect