Case Report: Acute Retinal Necrosis after a Cervical Epidural Steroid Injection

Abstract

SIGNIFICANCE: Acute retinal necrosis is a rare, sight-threatening condition typically found in immunocompromised patients and is most commonly caused by varicella zoster virus. Because of the poor prognosis and rapid progression of the disease course, prompt antiviral management is paramount. PURPOSE: A case report of acute retinal necrosis in a patient with herpes virus infection after a cervical epidural corticosteroid injection was performed. Extensive laboratory work and frequent follow-ups are necessary for management. This case report outlines the clinical signs of acute retinal necrosis and discusses the appropriate referrals and treatment needed to improve prognosis.CASE REPORT: A 63-year-old man presented to our eye clinic with symptoms of pain and light sensitivity. Examination revealed anterior uveitis, vitritis, optic disc edema, macular edema, vasculitis, and retinitis of the left eye. The serum antibody test results showed abnormal ranges for varicella zoster virus and herpes simplex virus type 1, and the patient was diagnosed with acute retinal necrosis. Treatment prescribed by a retina specialist included oral valacyclovir and later oral prednisolone, for which the patient responded well before developing the common complication of retinal detachment. CONCLUSIONS:The progressive nature of acute retinal necrosis is usually debilitating to vision, even when managed properly. Because prognosis is often poor, it is important to make proper diagnoses combined with a complete review of the patient's medical history and immune status to prevent further vision loss.

Acute retinal necrosis in a patient with cervical malignant tumor treated with sintilimab: a case report and literature review

“…Typically, ARN occurs in immunocompetent individuals; however, it may also occur in immunocompromised patients, such as those who are suppressed via corticosteroids ( 18 ), non-corticosteroid immunosuppressants ( 19 ), and chemotherapeutics ( 20 ). Viral reactivation is considered the main route of infection in ARN in infected cases.…”

Diagnostic and therapeutic challenges in acute retinal necrosis; an update

“…Additionally, ARN has been linked to COVID-19 vaccination, as reported by other researchers [ 91 ]. Other potential causes of ARN reported in the literature include herpes zoster vaccination [ 92 ], cervical epidural steroid injection [ 93 ], intravitreal dexamethasone implant [ 94 ], cataract surgery [ 95 ], and intravitreal ranibizumab for exudative macular degeneration [ 96 ].…”