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Atypical acute retinal necrosis accompanied by Terson's syndrome: a case report.

Abstract Acute retinal necrosis (ARN) has characterized by panuveitis, vitritis, severe vaso-occlusive vasculitis, and diffuse necrotizing retinitis. There are no case reports on atypical ARN combined with Terson's syndrome. Herein, we report a case of ARN with atypical clinical features combined with Terson's syndrome that we successfully treated by intravitreal ganciclovir injection.
PMID
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Authors

Mayor MeshTerms
Keywords

Acute retinal necrosis

Intravitreal ganciclovir injection

Terson’s syndrome

Journal Title bmc ophthalmology
Publication Year Start




PMID- 29258454
OWN - NLM
STAT- MEDLINE
DCOM- 20180105
LR  - 20180105
IS  - 1471-2415 (Electronic)
IS  - 1471-2415 (Linking)
VI  - 17
IP  - 1
DP  - 2017 Dec 19
TI  - Atypical acute retinal necrosis accompanied by Terson's syndrome: a case report.
PG  - 255
LID - 10.1186/s12886-017-0655-4 [doi]
AB  - BACKGROUND: Acute retinal necrosis (ARN) has characterized by panuveitis,
      vitritis, severe vaso-occlusive vasculitis, and diffuse necrotizing retinitis.
      There are no case reports on atypical ARN combined with Terson's syndrome.
      Herein, we report a case of ARN with atypical clinical features combined with
      Terson's syndrome that we successfully treated by intravitreal ganciclovir
      injection. CASE PRESENTATION: A 64-year-old man visited our eye clinic with a
      complaint of decreased visual acuity in his right eye. At the initial visit, his 
      best corrected visual acuity was 20/125 in the right eye. Slit-lamp examination
      demonstrated mild hyperemia, keratic precipitates, and anterior chamber
      inflammatory reaction. Fundus examination revealed multiple diffuse
      white-yellowish infiltrations in the peripheral retina combined with dot
      hemorrhages. Ultra-wide-field fluorescence angiography showed obstructive
      arteritis with peripheral non-perfusion and leakage from the retinal vessels. As 
      a result of the PCR analysis, varicella zoster virus DNA was identified in the
      aqueous humor. Under the diagnosis with VZV-mediated ARN, we started with
      intravenous acyclovir and oral prednisolone. After 3 days of the above treatment,
      the anterior chamber inflammation and vitreous opacity were increased. On fundus 
      examination, multiple whitish infiltrations were increased. In addition, newly
      developed vitreous and peripapillary hemorrhages were detected. On the T2 brain
      magnetic resonance imaging (MRI) demonstrated a sub-acute or old hemorrhagic
      infarction in the right occipital lobe, and contrast-enhancing lesions in the
      right basal ganglia. The spinal tapping was performed in the department of
      neurology in our hospital at the time when the patient complained of headache,
      and intracranial pressure was 31 mmHg. Under the diagnosis of ARN with Terson's
      syndrome, we started intravitreal ganciclovir (2 mg/0.5 ml) injections. After 5
      intravitreal ganciclovir injections over a period of 8 months, the diffuse
      whitish infiltrating retinal lesions combined with dot hemorrhage were decreased.
      The vitreous and peripapillary hemorrhage was significantly reduced. There was no
      recurrence in the patient's right eye, in which his visual acuity had improved to
      20/60. CONCLUSIONS: In the event of a poor response to traditional treatment such
      as intravenous acyclovir, intravitreal ganciclovir may have a role as an
      adjunctive therapy in patients of VZV associated ARN combined with Terson's
      syndrome.
FAU - Lee, Jong Young
AU  - Lee JY
AD  - Department of Ophthalmology, Jeju National University Hospital, Jeju National
      University School of Medicine, 1753-3 Ara-1 Dong, Jeju-Si, Jeju Self-Governing
      Province, Republic of Korea.
FAU - Kim, Dong Yoon
AU  - Kim DY
AD  - Department of Ophthalmology, Chungbuk National University College of Medicine,
      Cheongju, South Korea.
FAU - Lee, Hye Jin
AU  - Lee HJ
AD  - Department of Ophthalmology, Jeju National University Hospital, Jeju National
      University School of Medicine, 1753-3 Ara-1 Dong, Jeju-Si, Jeju Self-Governing
      Province, Republic of Korea.
FAU - Jeong, Jin Ho
AU  - Jeong JH
AD  - Department of Ophthalmology, Jeju National University Hospital, Jeju National
      University School of Medicine, 1753-3 Ara-1 Dong, Jeju-Si, Jeju Self-Governing
      Province, Republic of Korea.
FAU - Park, Sung Pyo
AU  - Park SP
AD  - Department of Ophthalmology, Kangdong Sacred Heart Hospital, Hallym University
      College of Medicine, Seoul, South Korea.
FAU - Kim, Jin Young
AU  - Kim JY
AUID- ORCID: http://orcid.org/0000-0001-6204-9537
AD  - Department of Ophthalmology, Jeju National University Hospital, Jeju National
      University School of Medicine, 1753-3 Ara-1 Dong, Jeju-Si, Jeju Self-Governing
      Province, Republic of Korea. [email protected]
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20171219
PL  - England
TA  - BMC Ophthalmol
JT  - BMC ophthalmology
JID - 100967802
SB  - IM
MH  - Humans
MH  - Intracranial Hemorrhages/*complications
MH  - Male
MH  - Middle Aged
MH  - Retinal Hemorrhage/pathology
MH  - Retinal Necrosis Syndrome, Acute/*pathology
MH  - Vitreous Hemorrhage/*pathology
PMC - PMC5735939
OTO - NOTNLM
OT  - Acute retinal necrosis
OT  - Intravitreal ganciclovir injection
OT  - Terson's syndrome
EDAT- 2017/12/21 06:00
MHDA- 2018/01/06 06:00
CRDT- 2017/12/21 06:00
PHST- 2017/06/02 00:00 [received]
PHST- 2017/12/11 00:00 [accepted]
PHST- 2017/12/21 06:00 [entrez]
PHST- 2017/12/21 06:00 [pubmed]
PHST- 2018/01/06 06:00 [medline]
AID - 10.1186/s12886-017-0655-4 [doi]
AID - 10.1186/s12886-017-0655-4 [pii]
PST - epublish
SO  - BMC Ophthalmol. 2017 Dec 19;17(1):255. doi: 10.1186/s12886-017-0655-4.