Refractory acute retinal necrosis presenting as peripapillary choroiditis – A diagnostic and therapeutic challenge

Refractory acute retinal necrosis presenting as peripapillary choroiditis – A diagnostic and therapeutic challenge

This report describes a challenging case of refractory acute retinal necrosis (ARN) with peripapillary choroiditis as the initial presenting sign. Imaging studies confirmed multifocal choroidal lesions and noted the novel sign of vertical hyper-reflective strips (VHRS) in the outer nuclear layer. In...

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Bibliographic Details
Main Authors: Ankush Kawali, Sai Bhakti Mishra, Padmamalini Mahendradas, Rohit Shetty
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2025-01-01
Series:Indian Journal of Ophthalmology
Subjects:
acute retinal necrosis
angular sign of henle’s hyper-reflectivity
choroiditis
famcyclovir
drug-resistant zoster
herpes zoster
varicella zoster virus
vertical hyper-reflective lesions
Online Access:https://journals.lww.com/10.4103/IJO.IJO_894_24
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Summary:This report describes a challenging case of refractory acute retinal necrosis (ARN) with peripapillary choroiditis as the initial presenting sign. Imaging studies confirmed multifocal choroidal lesions and noted the novel sign of vertical hyper-reflective strips (VHRS) in the outer nuclear layer. Initial treatment with acyclovir and valacyclovir failed, and involvement of the other eye suggested a resistant variant of varicella zoster virus. High-dose oral famciclovir therapy resulted in rapid resolution of ARN in both eyes. This case highlights the rare occurrence of choroiditis, the novel finding of VHRS, and the potential utility of high-dose oral famciclovir in treating refractory ARN.
ISSN:0301-4738
1998-3689

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