Varicella Zoster Virus-Induced Retinitis and Retinal Detachment in an Immunocompetent Patient: A Case Report

Objective: Unusual clinical course Background: Necrotizing herpetic retinopathies associated with varicella zoster virus (VZV) occurs sporadically and typically presents with acute retinal necrosis (ARN) features. This report presents an incident of ARN in an immunocompetent patient who was referred to the hospital for acute vision loss. Case Report: A 56-year-old previously healthy man presented to the Emergency Department with acute vision loss in his left eye. Four weeks before admission, he had an upper respiratory tract infection and received a diagnosis of VZV infection, based on skin examination and medical history. On ophthalmological examination in our hospital, the left eye showed exudative retinal detachment with necrotizing retinitis and profound uveitis. Blood tests for infectious diseases and opportunistic infections were performed. Intravenous antiviral treatment was started empirically, due to high suspicion of ARN. Five days after presentation, vision deterioration necessitated pars plana vitrectomy (PPV). Surgical procedure included retinectomy, endolaser photocoagulation, and high-viscosity silicone oil tamponade. One week after PPV, the patient's best corrected visual acuity measured with the Snellen chart was 0.25. Three weeks later, best corrected visual acuity was 0.16. Three months later, dilated fundus examination indicated an attached retina and emulsified silicone oil. Conclusions: This case report highlights VZV retinitis severity and emphasizes the importance of considering VZV retinitis in the differential diagnosis of progressive outer retinal necrosis, also in immunocompetent patients. The complications of the disease's course should raise awareness about the need for prophylactic vaccination against VZV. When the course of the disease develops to retinal detachment, the decision of vitrectomy should not be postponed.