New Aspects of Viral Necrotizing Retinitis in Subacute Sclerosing Panencephalitis With Spectral-Domain Optical Coherence Tomography

In Brief Purpose: To report the clinical, angiographic, and tomographic features of an adult patient with bilateral occlusive vasculitis and necrotizing retinitis preceding the onset of subacute sclerosing panencephalitis by 3 years. Methods: Observational case report. Results: A 39-year-old white man presented with sudden onset of decreased vision in his left eye. The patient reported a history of right visual loss 3 years ago after an episode of retinal vasculitis of unknown origin. At presentation, left fundus examination showed sensory retinal detachment and retinal hemorrhages in the left macula. Fluorescein angiography revealed occlusive vasculitis. Two weeks later, several circumscribed lesions of necrotizing retinitis appeared in the macula and in the midperiphery after a centrifugal linear pattern from the optic nerve. Spectral-domain optical coherence tomography demonstrated focal areas of moth-eaten disorganization of the ganglion cell and nuclear layers with a spreading from the inner layers to the outer layers. Conclusion: This unusual case of adult-onset subacute sclerosing panencephalitis may help improve our knowledge regarding the mechanism of retinal involvement in this disease. Clinical and tomographic findings suggest a continuous transneuronal spread of the measles virus from ganglion cells to the photoreceptor cells. Spectral-domain optical coherence tomography performed over the necrotizing retinitis in a patient having subacute sclerosing panencephalitis showed an extensive moth-eaten appearance of the retina with destruction of the neuronal layers. These findings suggest that the measles virus is transmitted transneuronally from the central nervous system to the retinal neurons.