Reactivation of Acute Retinal Necrosis following SARS-CoV-2 Infection

Abstract

Purpose: To report on a case of reactivation of acute retinal necrosis following SARS-CoV-2 infection.

Methods: Observational case report. Observations. A 32-year-old female with a distant history of left retinal detachment secondary to necrotizing herpetic retinitis complained of right-eye vision loss, pain, redness, and photophobia. An ophthalmological examination revealed findings consistent with acute retinal necrosis of the right eye. A polymerase chain reaction (PCR) analysis of the right vitreous was positive for herpes simplex virus type 2 (HSV-2). A coronavirus disease 2019 (COVID-19) screening test using reverse transcriptase- (RT-) PCR was positive for SARS-CoV-2 RNA.

Conclusions: Our case suggests that COVID-19 may cause a latent HSV infection to reactivate, causing contralateral involvement in patients with a prior history of HSV-associated acute retinal necrosis.

Figure 1

Ultra-widefield fundus photographs of the right (a, c) and left (b, d) eyes. Forty-three months prior to presentation, though the right eye remained uninvolved (a), the left eye developed extensive necrotizing retinitis involving over 80% of the retina. At presentation, the right eye (c) shows vitreous opacities, blurring of the disk margins, and retinal necrosis extending from 1 to 11 o'clock in zones 2 and 3 and diffusely in zone 1, sparing a small patch of the retina temporal to the optic disk. The left eye (d) has persistent retinal traction with fibrous tissue.