PT - JOURNAL ARTICLE AU - Phey Feng Lo AU - Rongxuan Lim AU - Serafeim N Antonakis AU - Goncalo C Almeida TI - Progressive outer retinal necrosis: manifestation of human immunodeficiency virus infection AID - 10.1136/bcr-2014-207344 DP - 2015 May 06 TA - BMJ Case Reports PG - bcr2014207344 VI - 2015 4099 - http://casereports.bmj.com/content/2015/bcr-2014-207344.short 4100 - http://casereports.bmj.com/content/2015/bcr-2014-207344.full AB - We present the case of a 54-year-old man who developed progressive outer retinal necrosis (PORN) as an initial manifestation of HIV infection without any significant risk factors for infection with HIV. PORN is usually found as a manifestation of known AIDS late in the disease. Our patient presented with transient visual loss followed by decrease in visual acuity and facial rash. Subsequent investigation revealed anterior chamber tap positive for varicella zoster virus (VZV), as well as HIV positivity, with an initial CD4 count of 48 cells/µL. Systemic and intravitreal antivirals against VZV, and highly active antiretroviral therapy against HIV were started, which halted further progression of retinal necrosis. This case highlights the importance of suspecting PORN where there is a rapidly progressive retinitis, and also testing the patient for HIV, so appropriate treatment can be started.