Acute retinal necrosis in a patient on immunosuppressive treatment for COVID-19 pneumonia: a case report

• Published in: BMC ophthalmology Vol. 22; no. 1; pp. 462 - 5
• Main Authors: Nishiyama, Takeyuki, Tsujinaka, Hiroki, Mizusawa, Yutaro, Ueda, Tetsuo, Ogata, Nahoko
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 30.11.2022; BioMed Central; BMC
• Subjects: Acuity; Acute retinal necrosis; Aged; Analysis; Antibiotics; Antiviral drugs; Autoimmune diseases; Bacterial infections; Bacterial pneumonia; Blood vessels; Cancer; Care and treatment; Case Report; Case reports; Coronaviruses; Corticosteroids; COVID-19; Disease; Epstein-Barr virus; Epstein-Barr Virus Infections; Exudates; Eye; Female; Fungal infections; Glaucoma; Health aspects; Herpesvirus 4, Human; Humans; Immunosuppression; Immunosuppressive Agents - adverse effects; Inflammation; Levofloxacin; Medical personnel; Mononucleosis; Necrosis; Ophthalmology; Patients; Pneumonia; Polymerase chain reaction; Prednisolone; Retina; Retinal Necrosis Syndrome, Acute - diagnosis; Retinal Necrosis Syndrome, Acute - drug therapy; SARS-CoV-2; Serology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Silicones; Steroid hormones; Steroids; Tamponade; Uveitis; Visual acuity; Japan; COVID-19; Immunosuppression; Pneumonia; Acute retinal necrosis; Epstein–Barr virus; Uveitis
• ISSN: 1471-2415; 1471-2415
• DOI: 10.1186/s12886-022-02692-5

Patients with coronavirus disease 2019 (COVID-19) occasionally develop ocular complications. We report a case of acute retinal necrosis (ARN) caused by Epstein-Barr Virus (EBV) that developed in a patient who had severe acute respiratory syndrome due to SARS-CoV-2 infection. A 68-year-old woman complained of floaters and blurred vision in her right eye as she was receiving systemic prednisolone for COVID-19 pneumonia under isolation in our hospital. The patient visited an ophthalmologist following her discharge from the hospital and after the 2 weeks of isolation had ended. At the initial examination, her best-corrected visual acuity (BCVA) was 20/100 in the right eye, and the eye showed moderate anterior segment inflammation and vitreous opacities. Treatment was initiated with topical 0.1% betamethasone and 1.5% levofloxacin. After 1 month, the inflammation in the right eye decreased and her BCVA improved to 20/40. However, on day 48 from her initial visit, the inflammation in her right eye worsened and her BCVA decreased to 20/2000 by day 80. Pars plana vitrectomy with silicone oil tamponade was performed to remove the vitreous opacities, and expanded white exudates peripherally and retinal vessels with white sheathing suggestive of acute retinal necrosis (ARN) were seen intraoperatively. Analysis of the vitreous sample revealed EBV positivity on polymerase chain reaction. The patient was diagnosed with EBV-associated ARN and treated with systemic steroids and valaciclovir. The ocular inflammation gradually decreased, and she was discharged from the hospital. However, a week later, the inflammation in the right eye markedly worsened. Despite another course of steroids, the inflammation worsened, resulting in total retinal detachment and absolute glaucoma. Because of the severe pain, the right eye was enucleated. Clinicians should be aware that COVID-19 and immunosuppressive treatment can reactivate EBV in the eye.