[Rapidly progressive outer retinal necrosis in a patient with acquired immunodeficiency syndrome]

We report a case of rapidly progressive varicella zoster virus retinitis, which is distinct from acute retinal necrosis syndrome. The patient was a 52-year-old male and suffered acquired immunodeficiency syndrome. Two months after the varicella zoster dermatitis in the distribution of the first division of the left trigeminal nerve, pseudodendritic keratitis and iridocyclitis were observed in the left eye. After 5 weeks, multifocal and patchy white exudates were observed in the peripheral deeper layer of the retina in the left eye, but retinal vasculitis in the exudative lesions was slight. Despite systemic administration of acyclovir, white exudates progressed confluently from the periphery to the post pole of the retina and reached the macula in 10 weeks. Eight weeks after the observation of lesions in the left eye, we found the same lesions in the right eye. After the white exudative lesions disappeared, the retina became atrophic and the retinal vessels were narrowed, but no retinal detachment was observed. Recently, Foster and associates described the rapidly progressive outer retinal necrosis as a new entity of varicella zoster virus retinitis in AIDS patients. We think our case was very similar to the rapidly progressive outer retinal necrosis. This case shows that we must carefully follow up the rapidly progressive outer retinal necrosis in the AIDS patients with a varicella zoster dermatitis.