Presumed Herpesviridae-associated acute retinal necrosis in a monocular adult: A case highlighting postpartum risk.

Purpose: This case report describes a monocular woman with presumed Herpesviridae-associated acute retinal necrosis (ARN), including an atypical presumed postpartum reactivation and implications for long-term management. Observations: A 26-year-old woman with a history of presumed bilateral childhood-onset Herpesviridae-associated ARN, status post right-eye enucleation, arrived at initial presentation with acute vision changes in her remaining functional eye. Examination revealed anterior chamber cells, elevated intraocular pressure, and peripheral retinal whitening concerning for ARN reactivation. She was treated aggressively with intravitreal antivirals, high-dose systemic antivirals, and corticosteroids, with return of vision to 20/20. Eleven days postpartum two years later, she presented with visual symptoms, but imaging demonstrated persistence of retinal whitening with inferior extension. Increase of systemic antivirals dosing led to clinical improvement, suggesting possible atypical viral reactivation. Nearly three years later, she developed reduced vision, vitreous inflammation, and an intraocular pressure spike, requiring repeat intravitreal therapy and transition to high-dose antivirals. Conclusions and importance: This report potentially illustrates the unpredictable course of suspected ARN, highlighting the need for aggressive empiric therapy and careful long-term surveillance. It emphasizes knowledge gaps regarding postpartum immune triggers, management strategies, and transition of pediatric ARN to adult retinal care.