Necrotizing retinitis of multifactorial etiology

Area of Science:

• Ophthalmology
• Virology
• Infectious Diseases

Background:

• Osteoporosis in elderly patients can present with complex ocular manifestations.
• Sudden vision loss and ocular pain warrant a thorough investigation for infectious etiologies.

Observation:

• A 73-year-old woman presented with acute vision loss and ocular pain.
• Ophthalmological examination revealed panuveitis and necrotizing retinitis in the right eye.
• Systemic symptoms included weight loss, fever, leukocytosis, monocytosis, thrombocytosis, and anemia.

Findings:

• Serological tests confirmed Cytomegalovirus (CMV) IgG and Herpes Simplex Virus (HSV) type 1 IgM positivity.
• Secondary hepatic cytolysis was noted, with no evidence of neoplastic disease or other immunosuppressive conditions.
• Treatment with corticotherapy and antiviral therapy resulted in significant visual recovery (BCVA 20/30).

Implications:

• This case underscores the importance of considering viral retinitis (CMV and HSV) in elderly patients with unexplained vision loss.
• Prompt diagnosis and combined antiviral and anti-inflammatory treatment can lead to favorable visual outcomes.
• The association with secondary hepatic cytolysis highlights the systemic impact of these viral infections.