Acute retinal necrosis associated with dimethyl fumarate

Area of Science:

• Ophthalmology
• Neurology
• Infectious Diseases

Background:

• The complete spectrum of side effects for disease-modifying therapies (DMTs) in multiple sclerosis (MS) is not fully understood.
• Dimethyl fumarate (DMF) is an MS DMT associated with four reported cases of serious varicella zoster virus (VZV) infections.
• VZV infections represent a potential risk associated with DMF treatment for MS.

Purpose of the Study:

• To report a case of acute retinal necrosis (ARN) in an MS patient treated with DMF.
• To highlight the potential for VZV infections to manifest with ocular symptoms in MS patients on DMF.
• To increase awareness of ARN as a differential diagnosis for visual disturbances in MS patients undergoing DMT.

Main Methods:

• Case report of a 44-year-old male with relapsing-remitting MS on DMF.
• Presentation of unilateral ocular symptoms including pain and visual impairment.
• Ophthalmological examination and vitreous polymerase chain reaction (PCR) for VZV.

Main Results:

• The patient presented with panuveitis, arteritis, retinitis, and vitritis.
• Vitreous PCR confirmed the presence of VZV.
• The diagnosis of acute retinal necrosis (ARN) was established.

Conclusions:

• Acute retinal necrosis (ARN) caused by VZV can present with symptoms that mimic optic neuritis.
• MS patients on DMF therapy should be monitored for potential VZV-related ocular complications.
• Early recognition of ARN is crucial for appropriate management in MS patients.