Classical acute retinal necrosis in an immunocompetent patient

ABSTRACT

Acute retinal necrosis (ARN) is a fulminant viral uveitis characterized by peripheral necrotizing retinitis, occlusive vasculitis, and prominent vitritis. The reported incidence is approximately 0.63 cases/million/year. Although more commonly associated with immunocompromised states, ARN in immunocompetent individuals is rarely reported. We report a case of a 64-year-old immunocompetent female who presented with sudden, painless, progressive diminution of vision in the left eye for 2 weeks. Ocular examination revealed nongranulomatous keratic precipitates, anterior chamber inflammation, and vitritis. Fundus evaluation demonstrated well-demarcated peripheral necrotic retinal lesions with circumferential progression, associated with occlusive arteritis and nasal choroidal detachment. A clinical diagnosis of ARN was established based on the American Uveitis Society criteria. The patient was treated with intravitreal ganciclovir, systemic valacyclovir, and corticosteroids. Serial follow-up showed significant regression and eventual resolution of retinal lesions. This case highlights the importance of early diagnosis and prompt antiviral therapy in preventing sight-threatening complications, even in immunocompetent individuals.