Acute retinal necrosis refractory to treatment.
Ian R Reekie, Jekaterina Sidhom, Randhir Chavan
✦ AI-curated · Sources linked
Case in brief
A woman in her 60s presented with hypertensive uveitis in the right eye, followed by vitritis and retinitis. An anterior chamber sample was positive for herpes simplex virus by PCR. Retinal necrosis and haemorrhages progressed despite oral valaciclovir and an initial intravitreal foscarnet injection. Repeat sampling identified aciclovir-resistant viral strains. Repeated intravitreal and intravenous foscarnet temporarily stabilised the condition, but the retina later detached.
What made this case unusual
Progression despite antiviral treatment prompted repeat PCR testing, which confirmed aciclovir-resistant herpes simplex virus in a case of acute retinal necrosis.
Diagnostic / clinical pearl
When acute retinal necrosis worsens or fails to stabilise on initial antiviral therapy, consider antiviral resistance and reassess with virological testing.
Why it matters
Intravenous foscarnet may carry unpleasant and potentially dangerous adverse effects, so patients should be counselled about these risks.