DOI: 10.36347/sjmcr.2016.v04i03.011

Pages: 154-158

The objective is to report a case of acute retinal necrosis (ARN) syndrome in a bortezomib-based therapy patient with acyclovir prophylaxis. A 61 years old Malay man with plasma cell leukemia, diabetes mellitus and hypertension, presented with 4weeks history of blurring of vision, photophobia and slight pain on the left eye. He had been under chemotherapy for plasma cell leukemia for the past 5 months consisted of bortezomib, cyclophosphamide and dexamethasone. Acyclovir prophylaxis was given to prevent reactivation of ARN. On examination, the left eye had visual acuity of 6/12 and the right eye had visual acuity of 6/9. There was no relative afferent pupillary defect. The left eye revealed high intraocular pressure of 44mmHg with 1+ of cells in the anterior chamber. Fundus showed a well-demarcated necrotic retina at the peripheral extended from 10-12 o’clock. It was associated with vitritis. The right eye had insignificant finding. A clinical diagnosis of left ARN syndrome was made and treated with intravenous acyclovir and followed by oral dose. The ARN initially showed slow recovery to the antiviral therapy until the bortezomib was was replaced by a substitute. Interestingly, his condition dramatically improved. The final visual outcome of the left eye was good and there were no complications or recurrence after three months of follow-up. Varicella-Zoster Virus (VZV) reactivation is one of the common complications encountered in the patients with bortezomib-based chemotherapy. However, there is limited data on ocular VZV reactivation in these patients. Numbers of reports have shown that this complication can be prevented by giving the acyclovir prophylaxis during the course of therapy, but it may still occur Hence, regular ocular examination is remained important.