[Acute Retinal Necrosis Caused by VZV and EBV Co-Infection in Patient with Hodgkin Lymphoma History]

Varicella Zoster Virus (VZV) is a common cause for acute retinal necrosis (ARN). On the other hand, Epstein-Barr Virus (EBV) is considered a rare cause for viral retinitis. Ocular co-infection with two viruses or more was described in a few isolated cases. In this case report, a 61 year old female with a history of Hodgkin lymphoma presented to the ophthalmic ER because of painless vision loss in her left eye. There was an inflammatory reaction +3 in both eyes. It was a normal fundus examination in the right eye. Fundus examination of the left eye showed 1+ vitreous haze, papillitis, the retina was flat with peripheral foci of retinal necrosis with discrete borders, exudates and perivascular sheathing. Fluorescein angiography of the right eye was normal and in the left eye demonstrated occlusive vasculitis and dye leakage from the peripheral foci. Vitreous tap revealed high titer VZV and lower titer EBV infection. Intravenous acyclovir and intravitreal foscarnet injections and systemic prednisone were started. After one week the patient developed retinal detachment in the lower part. Surgical intervention was performed. An improvement was shown after the surgery and there was a reduction in the retinal lesions, as a result the anti-viral dosage was reduced. In her next visits a further deterioration was observed - that manifested in exudative retinal detachment and retinal hemorrhage as an expression for ARN. Peeling and retinotomy surgery and frequent follow-ups in the uveitis clinic were the following steps. ARN caused by co-infection with VZV and EBV can by treatment-resistant, especially in immunosuppressive patients. Patients can benefit from early detection and intervention and frequent follow-up.