Disseminated Varicella-Zoster Virus-Associated Acute Retinal Necrosis in a Post-Bone Marrow Transplant Patient

Abstract

Purpose: This case report highlights the risk of viral infections, particularly acute retinal necrosis (ARN), in patients undergoing immunosuppressive therapy for graft-versus-host disease (GVHD) following bone marrow transplantation.

Methods: A 45-year-old male with aplastic anaemia who underwent a bone marrow transplantation developed GVHD and was treated with ruxolitinib and tacrolimus. The patient presented with ocular symptoms and was diagnosed with pseudodendritic keratitis in the right eye and ARN in the left eye. The diagnosis was confirmed through PCR analysis of the anterior chamber tap.

Results: The patient's right eye symptoms were resolved with topical acyclovir and supportive care, achieving a best-corrected visual acuity of 6/6. Following systemic and intravitreal antiviral therapy, ARN resolved in left eye with thinning and retinal detachment. The patient was not cleared for surgery due to his compromised systemic condition.

Conclusion: Our case highlights the disseminated and asymmetric nature of herpes zoster infection in the context of severe immunosuppression. This emphasizes the need to balance effective GVHD treatment and reinforces the importance of ongoing vigilance and timely management of these high-risk individuals.

Keywords: Acute retinal necrosis; aplastic anemia; disseminated infection; graft versus host disease.