PMC4435049_01
Fundus photographs of the left eye of the patient upon presentation at our hospital.. Notes: The photographs revealed multiple areas of confluent necrotizing retinitis and occlusive vasculitis at the posterior pole (A) and the temporal periphery (B) with overlying vitritis consistent with acute retinal necrosis.
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On examination, there were 2+ aqueous cells in the anterior chamber and mutton-fat keratic precipitates, and the following were also observed: 3+ vitreous cells, vasculitis in the temporal arcade, and white patches of retinal necrosis in the temporal part of the posterior pole and peripheral retina (Figure 1).
Agarose gel electrophoresis of the PCR products from vitreous.. Notes: Positive controls (A) and vitreous sample from the patient (B). Lane 1: HSV-1; lane 2: HSV-2; lane 3: VZV; lane 4: EBV; lane 5: CMV; lane 6: HHV-6A/B; and lane 7: HHV-7. VZV and CMV were detected (B).. Abbreviations: PCR, polymerase chain reaction; HSV, herpes simplex virus; VZV, varicella-zoster virus; EBV, Epstein-Barr virus; CMV, cytomegalovirus; HHV, human herpes virus.
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The results of the PCR of vitreous were positive for VZV and CMV and negative for HSV, EBV, and human herpes virus 6 and 7 (Figure 2).
Gradual resolution of the retinitis and occlusive vasculitis with treatment.. Notes: Gradual resolution of the retinitis and occlusive vasculitis with treatment (silicon oil in situ): day 2 (A), day 5 (B), day 8 (C), and day 20 (D) after admission to our hospital.
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Although the patient was given only acyclovir, the white patches gradually disappeared or cicatrized (Figure 3).