Idiopathic Photoreceptoritis: An Unusual Variant of Outer Retinopathy.

Abstract

Purpose: To report an unusual case of progressive photoreceptor disruption following a herpetic labial infection.

Method: Case report of a patient with severe idiopathic photoreceptoritis.

Results: A 46-year-old female patient presented with blurred vision and inferior photopsia in her right eye one week after a herpetic labial eruption. Initial examination revealed mild vitreous inflammation and focal photoreceptor alterations in the superior periphery of the right retina. Despite oral valaciclovir, the disease progressed rapidly, prompting referral to a tertiary care center. Autofluorescence and optical coherence tomography showed diffuse photoreceptor damage with impending foveal involvement. Extensive workup, including viral markers, was inconclusive. Given the temporal association with the herpetic infection and the sight-threatening progression, treatment was escalated to intravenous acyclovir and subsequently foscarnet for 2 weeks, which slowed down disease progression. The frontal margin of retinal foci stabilized with no further progression, while ellipsoid zone restoration was achieved following systemic corticosteroids and interferon alpha-2a.

Conclusion: The term "photoreceptoritis" describes conditions involving diffuse photoreceptor damage, predominantly unilateral, without primary choriocapillaritis. This case highlights a severe form of photoreceptoritis with diffuse photoreceptors loss, likely triggered by a herpetic labial infection. The disease was stabilized with antiviral therapy, while structural recovery of the photoreceptors was achieved through anti-inflammatory and immunosuppressive treatments. This report underscores the importance of a multidisciplinary approach to managing atypical retinal inflammatory disorders.