UNVEILING THE MASQUERADE: A CASE OF CMV - ASSOCIATED ACUTE RETINAL NECROSIS
Muhammad Nasiruddin M.S., Ahmad Azhari A.T., Muzaliha M.N., Khairuddin O. & Ropilah A.R.
abstract
Acute retinal necrosis (ARN) is a rare but severe intraocular inflammatory condition that can lead to profound vision loss if not promptly treated. It is most frequently associated with the Herpes virus family, including Varicella-Zoster Virus (VZV) and Herpes Simplex Virus (HSV), but cytomegalovirus (CMV)-related ARN has also been reported, particularly in immunocompromised or systemically unwell individuals. We present a case of ARN in a 62-year-old woman with diabetes mellitus, hypertension, and dyslipidemia, who demonstrated progressive visual impairment preceded by severe floaters and was found to have CMV-positive vitreous specimen. Early intervention with intravenous ganciclovir led to a notable improvement in visual acuity and resolution of vitritis. This case underscores the importance of comprehensive evaluation for infectious etiologies, including CMV, in patients with ARN who have underlying systemic comorbidities and highlights the need for timely antiviral therapy.
references
1. Gary N Holland; progressive outer retinal necrosis. International Ophthalmology 18: 163-165,1994.
2. Chun H. Lau, Tom Missotten, Joel Salzmann, Susan L. Lightman. Acute retinal necrosis: features, management and outcomes.Ophthalmology . 2007; 114(4): 756-762.
3. Wong RW, Jumper JM, McDonald HR,Johnson RN Fu A,Lujan BJ,Cunningham ET. Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol. 2013;97(5):545-552.doi 10.1136/bjophthalmol-2012-301983.
4. Powell B, Wang D,Llop S,Rosen RB. Management strategies of Acute Retinal Necrosis: current perspectives. Clinical Ophthalmology 2020;14: 1931-1943.
5. Scott D. Schoenberger,Stephen J,Kim, Jennifer E.Thorne, Prithvi Mruthyunjaya, Steven Yeh,Sophie J. Bakri, Justis P. Ehlers. Diagnosis and treatment of acute retinal necrosis: a report by the American Academy of Ophthalmology. Ophthalmology. 2017;124(3):382-392.
6. Jing Zhang Koju Kamoi,Yuan Zong,Mingming Yang,Yaru Zou,Miki Miyagaki,Kyoko Ohno Matsui. Cytomegalovirus Retinitis: Clinical manifestations,diagnosis and treatment. Viruss.2024 16(9): 1427 doi 177u0, JOHNSON.3390/v6091427.
7. Dimitrios K, Farid Afshar,Chris K, Georgios V, Andrew JL. Diagnostic and therapeutic challenges in acute retinal necrosis: An Update. Eye. 2024 38((10): 1816-1826.
2. Chun H. Lau, Tom Missotten, Joel Salzmann, Susan L. Lightman. Acute retinal necrosis: features, management and outcomes.Ophthalmology . 2007; 114(4): 756-762.
3. Wong RW, Jumper JM, McDonald HR,Johnson RN Fu A,Lujan BJ,Cunningham ET. Emerging concepts in the management of acute retinal necrosis. Br J Ophthalmol. 2013;97(5):545-552.doi 10.1136/bjophthalmol-2012-301983.
4. Powell B, Wang D,Llop S,Rosen RB. Management strategies of Acute Retinal Necrosis: current perspectives. Clinical Ophthalmology 2020;14: 1931-1943.
5. Scott D. Schoenberger,Stephen J,Kim, Jennifer E.Thorne, Prithvi Mruthyunjaya, Steven Yeh,Sophie J. Bakri, Justis P. Ehlers. Diagnosis and treatment of acute retinal necrosis: a report by the American Academy of Ophthalmology. Ophthalmology. 2017;124(3):382-392.
6. Jing Zhang Koju Kamoi,Yuan Zong,Mingming Yang,Yaru Zou,Miki Miyagaki,Kyoko Ohno Matsui. Cytomegalovirus Retinitis: Clinical manifestations,diagnosis and treatment. Viruss.2024 16(9): 1427 doi 177u0, JOHNSON.3390/v6091427.
7. Dimitrios K, Farid Afshar,Chris K, Georgios V, Andrew JL. Diagnostic and therapeutic challenges in acute retinal necrosis: An Update. Eye. 2024 38((10): 1816-1826.