Periarterial Plaques (Kyrieleis’ Arteriolitis) in a Case of Bilateral Acute Retinal Necrosis

Abstract

Purpose: To describe unilateral periarterial plaque in a case of bilateral acute retinal necrosis (BARN) due to varicella zoster virus (VZV). Methods: Case report. Results: A 43-year-old diabetic male presented to us with dimness of vision in the left eye for three months. He was already on oral steroids and anti-viral therapy. Best-corrected visual acuity was 6/6 OD and hand movements close to face OS. The right eye showed inferior and temporal retinal thinning and pigmentation and periarterial whitish focal Kyrieleis’ plaques, specifically along arterioles. Left eye had mild vitritis, optic disc pallor, arteriolar attenuation, with retinal whitening and areas of pigmentation involving 360° of peripheral retina along with some involvement of the posterior pole. Serology for human immunodeficiency virus (HIV), herpes simplex virus (HSV), and cytomegalo virus (CMV) was negative. IgM for VZV was positive. Oral Valacyclovir 1 g thrice daily was continued and a slow taper of oral steroids was instituted. Conclusions: ARN should be considered as a differential diagnosis in cases with Kyrieleis’ plaques and a peripheral retinal examination must be done to rule out patches of healed retinitis and vasculitis.

• Arteriolitis
• herpetic retinitis
• Kirisawa's uveitis
• varicella zoster virus
• vasculitis

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.