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Case Reports
. 2018 Nov 28;11(1):e227290.
doi: 10.1136/bcr-2018-227290.

Acute retinal necrosis (ARN) following chickenpox in a patient of Vogt-Koyanagi-Harada (VKH) syndrome using immunosuppressants

Rajan Gupta  1 , Mudit Tyagi  1 , Divya Balakrishnan  1 , Padmaja Kumari Rani  1
Affiliations
Case Reports

Acute retinal necrosis (ARN) following chickenpox in a patient of Vogt-Koyanagi-Harada (VKH) syndrome using immunosuppressants

Rajan Gupta et al. BMJ Case Rep. .

Abstract

A 36-year-old woman presented with diminution of vision and floaters in both the eyes. Both eyes had disc oedema, multiple pockets of neurosensory detachments along with vitritis. Fluorescein angiography and optical coherence tomography showed characteristic features of Vogt-Koyanagi-Harada (VKH) syndrome (figure 1). She was started on corticosteroid pulse therapy and immunosuppressants following which her VKH lesions resolved. However, she developed chickenpox after 2 weeks and after 1 month she developed discrete yellowish white retinitis patches in the periphery of the right eye which were consistent with a diagnosis of acute retinal necrosis. She was started on oral antivirals for the same and immunosuppressants were withheld in view of immunocompromised state potentially acting as a trigger for reactivation of latent virus. Retinitis patches started to resolve and showed a favourable response to the treatment.

Keywords: infectious diseases; retina.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Fundus photograph (top row) of the right and left eyes showing multiple pockets of NSDs (arrow). Fluorescein angiography (bottom row) showing pinpoint leaks in the early arteriovenous phase (arrow head). NSD, neurosensory detachment.
Figure 2
Figure 2
Swept source OCT of the right and left eyes showing multiple NSDs (arrow), RPE undulations (arrowhead) and septae arising from outer retinal layers (asterisk). NSD, neurosensory detachment; OCT, optical coherence tomography; RPE, retinal pigment epithelium.
Figure 3
Figure 3
Ultrasonography of the right and left eyes showing choroidal thickening (double-headed arrow) and NSDs (arrow). NSD, neurosensory detachment.
Figure 4
Figure 4
Montage view of the right eye showing peripheral confluent yellow-white retinitis patches without any evidence of vitritis in mid periphery.
Figure 5
Figure 5
Montage view of the right eye showing resolving retinitis patches with a centripetal pattern of resolution without pigmentation.
See this image and copyright information in PMC

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