| 본문 : Purpose : To report a case of bilateral ischemic retinal vasculitis 2 months after the onset of chickenpox
Case summary : A healthy 31-year-old female presented with a 2-week history of floater and blurred vision for a week. She had herpes simplex virus with cutaneous vesicular eruption and was treated with oral acyclovir 2 month ago. At presentation, best corrected visual acuity in both eyes was 20/32. Examination of the anterior segments was unremarkable and cell was present in anterior vitreous. Fundus examination revealed flat posterior pole with sheathing and vasculitis. Wide fluorescence angiography showed thickened extrafoveal retina and vascular leakage. Serologic test were positive for both immunoglobulin IgM and IgG anti-VZV antibodies, confirming recent primary VZV infection.
The patients was treated with antiviral agent combined with oral corticosteroid i.e. oral prednisolone 50mg for 1 week and tapering over 1 month in conjunction with acyclovir 400mg 5 times daily for 1 month. At 1 month, vascular leakage was decreased but photoreceptor disruption was observed on optical coherence tomography and sectoral visual field defect was observed on Humphrey visual field test. Her final best corrected visual acuity improved to 20/20 at follow up of 2 months, which was maintained for 1 year.
Conclusions : Ocular involvement after primary infection with varicella zoster virus (VZV) is very rare, usually occurring in children and young adolescents with acute retinal necrosis or optic neuritis. This case has demonstrated atypical clinical features of retinal vasculitis as compared to acute retinal necrosis or optic neuritis. |