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Khandwala NS, Miller JML, Hyde RA, et al. The Diagnostic Conundrum of Retinitis and a Pigmented Scar. Case Rep Ophthalmol. 2021;12(1):164-168doi: 10.1159/000513108.
Khandwala, N. S., Miller, J. M. L., Hyde, R. A., Conrady, C. D., Rao, R. C., & Besirli, C. G. (2021). The Diagnostic Conundrum of Retinitis and a Pigmented Scar. Case reports in ophthalmology, 12(1), 164-168. https://doi.org/10.1159/000513108
Khandwala, Nikhila S, et al. "The Diagnostic Conundrum of Retinitis and a Pigmented Scar." Case reports in ophthalmology vol. 12,1 (2021): 164-168. doi: https://doi.org/10.1159/000513108
Khandwala NS, Miller JML, Hyde RA, Conrady CD, Rao RC, Besirli CG. The Diagnostic Conundrum of Retinitis and a Pigmented Scar. Case Rep Ophthalmol. 2021 Apr 12;12(1):164-168. doi: 10.1159/000513108. eCollection 2021. PMID: 33976676; PMCID: PMC8077507.
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Case Rep Ophthalmol. 2021 Apr 12;12(1):164-168. doi: 10.1159/000513108. eCollection 2021.

The Diagnostic Conundrum of Retinitis and a Pigmented Scar.

Case reports in ophthalmology

Nikhila S Khandwala, Jason M L Miller, Robert A Hyde, Christopher D Conrady, Rajesh C Rao, Cagri G Besirli

Affiliations

  1. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.

PMID: 33976676 PMCID: PMC8077507 DOI: 10.1159/000513108

Abstract

We report a finding of a pigmented chorioretinal scar with acute retinal necrosis (ARN) caused by herpes simplex virus 2 (HSV-2) infection rather than toxoplasma, creating an initial diagnostic dilemma. A 53-year-old functionally monocular male presented with painless floaters and blurry vision in his seeing eye over a period of 4 days. An exam demonstrated anterior chamber (AC) reaction, vitritis, multifocal patches of whitening, and an occlusive retinal vasculitis. A superior pigmented chorioretinal scar with overlying contracted vitreous was noted in the periphery with no adjacent retinal whitening. The patient was treated for both ARN and toxoplasma chorioretinitis until PCR study of the vitreous and AC returned positive for HSV-2 and negative for toxoplasmosis. Management consisted of a dual therapy regimen of both oral and intravitreal antiviral agents as well as oral corticosteroids. The patient's clinical course was complicated by rhegmatogenous retinal detachment within 2 weeks after symptom onset, requiring pars plana vitrectomy with silicone oil and intraoperative intraocular incubation with foscarnet. We review emerging evidence for pigmented chorioretinal scars in ARN specifically caused by HSV-2, as well as diagnostic and treatment dilemmas in the management of ARN and ARN detachments.

Copyright © 2021 by S. Karger AG, Basel.

Keywords: Acute retinal necrosis; Herpes simplex virus 2; Pigmented chorioretinal scar; Retinal detachment; Toxoplasma uveitis

Conflict of interest statement

The authors have no conflicts of interest to declare.

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