Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report

Abstract

Background Patients with coronavirus disease 2019 (COVID-19) occasionally develop ocular complications. We report a case of acute retinal necrosis (ARN) caused by Epstein–Barr Virus (EBV) that developed in a patient who had severe acute respiratory syndrome due to SARS-CoV-2 infection. Case presentation A 68-year-old woman complained of floaters and blurred vision in her right eye as she was receiving systemic prednisolone for COVID-19 pneumonia under isolation in our hospital. The patient visited an ophthalmologist following her discharge from the hospital and after the 2 weeks of isolation had ended. At the initial examination, her best-corrected visual acuity (BCVA) was 20/100 in the right eye, and the eye showed moderate anterior segment inflammation and vitreous opacities. Treatment was initiated with topical 0.1% betamethasone and 1.5% levofloxacin. After 1 month, the inflammation in the right eye decreased and her BCVA improved to 20/40. However, on day 48 from her initial visit, the inflammation in her right eye worsened and her BCVA decreased to 20/2000 by day 80. Pars plana vitrectomy with silicone oil tamponade was performed to remove the vitreous opacities, and expanded white exudates peripherally and retinal vessels with white sheathing suggestive of acute retinal necrosis (ARN) were seen intraoperatively. Analysis of the vitreous sample revealed EBV positivity on polymerase chain reaction. The patient was diagnosed with EBV-associated ARN and treated with systemic steroids and valaciclovir. The ocular inflammation gradually decreased, and she was discharged from the hospital. However, a week later, the inflammation in the right eye markedly worsened. Despite another course of steroids, the inflammation worsened, resulting in total retinal detachment and absolute glaucoma. Because of the severe pain, the right eye was enucleated. Conclusions Clinicians should be aware that COVID-19 and immunosuppressive treatment can reactivate EBV in the eye.

Multicenter and multimodal imaging study reveals rare fundus lesions in patients after SARS-CoV-2 infection

“…No-infectious Retinal vein occlusion (RVO) 23,24 Retinal artery occlusion (RAO) 25 Purtscher-like retinopathy 26 Cotton-wool spots 27 Isolated hemorrhages 28 Acute macular neuroretinopathy (AMN) 29 Paracentral acute middle maculopathy (PAMM) 30 Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) 31 Multiple evanescent white-dot syndrome (MEWDS) Serpiginous choroiditis (SC) 32 Optic neuritis (ON) 33 Vogt-Koyanagi-Harada syndrome-like uveitis 34 Central serous chorioretinopathy (CSCR) 35 Infectious Endogenous endophthalmitis (Bacterial/Fungal) 36 Acute retinal necrosis (ARN) 37 Rhino-orbital-cerebral mucormycosis (ROCM) 38…”

A pyramid needs a foundation: Exploding some myths about what EVJ's editors are looking for from authors?

“…Case reports are particularly useful for sharing information and experiences of treating rare conditions, harms associated with therapy, recognition of new diseases and unusual presentations in recognised diseases. 53,54 Indeed, during the COVID pandemic, case reports were used to present potential therapeutic options for specific patient groups such as pregnant women, 55 that had not been addressed in the randomised controlled trials which were rapidly published in the face of this global emergency and to report unusual complications associated with infection [56][57][58][59] and with vaccination. 60,61 Case reports can have educational value, clinicians often enjoy reading them and compared to other forms of research reports, they are inexpensive and rapidly produced.…”

Atypical Peripheral Retinal Necrosis Without Ocular Inflammation and Retinal Whitening in a Patient With Acute Myelogenous Leukemia: A Case Report

“…Bacterial endophthalmitis or viruses cause retinal necrosis. Most cases caused by viruses are due to herpesviruses such as the herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) [1,2]. Herpetic retinal necrosis (NHR) is relatively rare, but retinal function, which is a part of the sensory organs, is frequently impaired by necrosis, and retinal detachment often occurs, leaving significant visual impairment [3].…”