Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired
immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the
Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead
to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We
describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/μL that
developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially
diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual
acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina
without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/μL.
She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and
vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and
intravitreous ganciclovir, the patient’s visual acuity worsened with no light-perception in either eye. This case
suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients
initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution
syndrome.

Keywords: Progressive outer retinal necrosis, Varicella-zoster virus, Acquired immunodeficiency syndrome,
Highly active antiretroviral therapy