Necrose retiniana aguda de etiologia presumível por herpesvírus

Abstract

Introduction: Acute retinal necrosis is a rare form of infectious necrotizing retinitis that affects individuals regardless of sex or age. It is characterized by an acute panuveitis, with associated retinal periarteritis, progressing to a diffuse necrotizing retinitis and, eventually, to retinal detachment. This study aims to report a case of acute retinal necrosis, with unilateral involvement and presumed etiology by herpesvirus. Case description: A 67-year-old man, complaining of eye pain and low visual acuity in his right eye, with 15 days of evolution. He had reduced visual acuity, anterior and posterior uveitis, with lesions suggestive of acute retinal necrosis. The patient was tested for HIV, tuberculosis, syphilis, toxoplasmosis and herpesvirus. He presented positive IgM and IgG for cytomegalovirus and positive IgG for herpes simplex virus, only. Despite the positive IgM for CMV, the treatment with Acyclovir was sustained due to the strong etiological suspicion of herpes simplex. The patient evolved with good response to treatment, progressing with clinical and visual improvement. Discussion: Acute retinal necrosis cases due to infection are frequently related to herpes simplex and varicella zoster viruses, but other viruses of the same family should be investigated. The diagnosis is clinical, in most cases, but etiological confirmation can be performed. The analysis of clinical and epidemiological factors, associated with the according classification of the onset uveitis and the observation of ophthalmological findings is a solid based thread for the etiological definition and for better management of the case. Complementary exams must be carefully requested, and the results must be associated with the clinical presentation before the medical conduct is chosen.