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PORN Prognosis — SCE Infectious Diseases MCQ

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HardHIV MedicinePORN PrognosisSCE Infectious Diseases

A 35-year-old man with HIV (CD4 40, not on ART) develops progressive retinal necrosis with rapid visual loss. Fundoscopy shows confluent areas of deep retinal whitening extending from the periphery toward the macula WITHOUT significant haemorrhage. CSF VZV PCR is positive. Despite IV Aciclovir and intravitreal Foscarnet, he develops retinal detachment. What long-term visual prognosis can he expect?

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Correct answer: E — Poor — progressive outer retinal necrosis (PORN) has very poor visual outcomes with retinal detachment occurring in >50% of cases despite treatment

PORN (progressive outer retinal necrosis) is caused by VZV in severely immunocompromised patients. It is characterised by rapid, painless, bilateral (in 70%) visual loss with deep retinal whitening WITHOUT significant haemorrhage (distinguishing it from CMV retinitis which has the 'pizza pie' appearance). Prognosis is very poor — retinal detachment occurs in >50% of cases despite treatment, and visual outcome is often no light perception. Treatment is IV Aciclovir (10 mg/kg TDS) plus intravitreal antivirals (Foscarnet or Ganciclovir). ART must be initiated urgently.

Reference: BHIVA 2022 – OI guidelines; AAO 2020 – PORN