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Persistence of Kyrieleis arteriolitis in bilateral acute retinal necrosis

Kaza, Hrishikesh; Patel, Anamika; Pathengay, Avinash

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Indian Journal of Ophthalmology: September 2020 - Volume 68 - Issue 9 - p 1974
doi: 10.4103/ijo.IJO_2009_19
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A 36-year-old immunocompetent male presented with bilateral acute retinal necrosis (BARN). Bilateral Kyrieleis arteriolitis continued to persist even after 4 months of retinitis resolution and discontinuation of therapy [Fig. 1a and b] Kyrieleis arteriolitis were described as focal segmental intra-arterial plaques that simulate arterial emboli.[1] They remain within the arterial wall or endothelium[2] and can be seen in tuberculosis, toxoplasmosis, cytomegalovirus (CMV) retinitis, syphilis, and Behcet's. There occurs deposition of immune cells or inflammatory debris within the vessel wall as an inflammatory response to infectious agents.[3] Therefore, persistence of Kyrieleis could occur even after the resolution of retinitis.

Figure 1
Figure 1:
(a) Right eye fundus photograph showing resolved acute retinal necrosis and presence of Kyrieleis arteriolitis (b) Left eye fundus photograph showing resolved acute retinal necrosis and presence of Kyrieleis arteriolitis. Presence of horseshoe tear at inferotemporal quadrant which was subsequently lasered

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Chawla R, Tripathy K, Sharma YR, Venkatesh P, Vohra R. Periarterial plaques (Kyrieleis' Arteriolitis) in a case of bilateral acute retinal necrosis Semin Ophthalmol. 2017;32:251–52
2. Pichi F, Veronese C, Lembo A, Invernizzi A, Mantovani A, Herbort CP, et al New appraisals of Kyrieleis plaques: A multimodal imaging study Br J Ophthalmol. 2017;101:316–21
3. Francés-Muñoz E, Gallego-Pinazo R, López-Lizcano R, García-Delpech S, Mullor JL, Díaz-Llopis M. Kyrieleis' vasculitis in acute retinal necrosis Clin Ophthalmol. 2010;4:837–8
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