Chickenpox Related Bilateral Ischemic Retinal Vasculopathy in an Immunocompetent 17 Year Old Male – A Rare Presentation


ABSTRACT

Ocular involvement after primary infection with varicella zoster virus is very rare. We report a case of a healthy 17-year-old man who presented with bilateral ischemic retinal vasculitis 15 days after the onset of chickenpox.

Medical History:

Two weeks after onset of the cutaneous vesicular eruptions, he experienced progressive blurring of vision in his right eye. At presentation, he had healed chicken pox scars . Best corrected visual acuity in his right eye was 20/80. Fundus examinations revealed pre-retinal and retinal haemorrhages, cotton wool spots, peri-venous exudation involving the temporal retina. Examination of the anterior segments was unremarkable. The media was clear with no anterior chamber reaction or vitritis and the disc and macula appeared healthy. His left eye was normal with 20/20 vision.

Fluorescein angiography of right eye revealed marked capillary drop out areas in the temporal retina ( periphery), peri-vascular leakage and staining with some leakage in the temporal para-foveal area. In the left eye, fluorescein angiography revealed few patches of peri-venous leakage in the periphery.

Management:

Both varicella virus IgG and IgM were (+) . Since the patient had not taken any medication for either chicken pox or his ocular problem, he was started on oral acyclovir 800 mg x 5 times/ day and oral steroid 1 mg/kg .The patient was not ready for admission due to financial constraints so he was asked to follow up after 1 week. At 1 week follow up, his vision had improved to 20/60, there was mild improvement in perivenous exudation. He was continued on oral acyclovir and oral steroid and asked to follow up in 2 weeks time.

Conclusion:

In conclusion, we report an immunocompetent 17-year- old Asian male who presented with retinal vasculitis in bilateral eye 3 weeks after chickenpox. After the treatment with acyclovir and oral corticosteroid , the best-corrected visual acuity improved from 20/80 to 20/60, with mild resolution of perivenous exudation. It is important to perform a detailed ocular examination from anterior segment to fundus in patients with varicella infection. Retinal vasculitis should be considered. Immediate recognition and proper treatment with systemic antiviral therapy may be essential for the prevention of severe sequelae and good visual acuity outcome. The patient is on regular follow up and we are yet to see the long term sequeale.


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Rajya Laxmi Gurung
Nepal
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