A 34-year-old male patient diagnosed with varicella three weeks before resolved without complications.
He came to the emergency room with decreased visual acuity in his left eye.
In the exploration, a corrected visual acuity of 1 in the right eye (OD) and 0.6 in the left eye (LE) was found.
The slit lamp shows a 4+ cellular tyndall in the left eye, precipitated or inferior to the right eye (3D+) and without fluorescein staining, being normal.
Intraocular pressure was 16mmHg in both eyes.
In the initial funduscopic examination of the left eye mild stenosis (1+) was observed without focal seizures.
A topical treatment with corticoids and midline
Two days later, a decrease in the anterior chamber (3+) of the cellular tyndall was observed, but at the bottom of the eye a peripheral focus of necrotizing colitis associated with temporary vasculitis appeared.
The patient was admitted to the hospital and started on intravenous therapy (10 mgr/kg/8 hours), antiplatelet therapy (acetylsalicylic acid 150 mgr/24 hours) and topical treatment was maintained.
Prophylactic photocoagulation with argon laser around the necrosis zone is also performed.
1.
After 48 hours and after checking for a good response with decreased focus of infection, corticosteroids were introduced at a dose of 1 mg/kg/d, showing rapid improvement in visual acuity and decrease in visual acuity.
Two weeks later, the antiviral treatment (famivir 500 mgr/12 hours) was started and corticoids gradually decreased at a rate of 10 mgr every week.
Antiviral treatment was continued at maintenance doses for 6 weeks, with periodic analytical controls blood count and biochemistry to detect renal involvement.
Six months after the onset of the disease, the patient remains asymptomatic, with visual acuity in the left eye unit, scarring of lesions and complete absence of ocular inflammatory activity in both eyes.
During admission, recent infection with varicella zoster virus was confirmed by seroconversion.
