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Photos courtesy of: Jan Geert Bollemeijer, M.D.
Used with permission. Not to be reproduced.

A 23-year-old HIV-positive female complains of a 4-week history of painless, decreased vision in both eyes. Above is the fundus appearance at presentation; there is minimal vitritis.

1.	Which of the following viruses could be associated with these fundus findings?
	e -- (c) and (d) VZV and HSV can cause acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) – the former may infect healthy individuals, whereas PORN is usually seen in the context of immunosuppression. The case described and the fundal findings suggest this is a case of PORN. CMV retintis would be more haemorrhagic or granular, but is seen in patients with HIV. EBV may lead to CNS lymphomas in HIV patients. HHV-8 is related to Kaposi’s sarcomas.
2.	The following would be suitable treatment(s) for this condition:
	b -- Aciclovir / Foscarnet Intravenous aciclovir or foscarnet could be used in this case – and/or intravitreal delivery of the same agents. The prognosis is very poor due to to the very high rate of retinal detachment. Conversely, ARN may respond to treatment, but retinal detachment repair is challenging due to the necrotic retina and number of breaks.
3.	Which of the following features are ‘typical’ of this condition?
	a -- It occurs at low CD4 counts in the context of HIV. The other answer ‘stems’ relate to the clinical features of acute retinal necrosis (ARN) which should be considered in the differential diagnosis. The table below illustrates the differences between ARN and PORN and some clinical pictures are shown here. Photos courtesy of: Jan Geert Bollemeijer, M.D. Used with permission. Not to be reproduced.