Acute Retinal Necrosis in an Infant With Corneal and Macular Scarring

Purpose: To report a rare case of neonatal acute retinal necrosis (ARN) caused by herpes simplex virus type 2 (HSV-2), highlighting its clinical features, diagnostic challenges, and management outcomes. Methods: A single case was reviewed. Results: ARN is a rare and rapidly progressive ocular condition caused by intraocular herpesvirus infections, including HSV and varicella-zoster virus (VZV). ARN is uncommon in neonates, with few cases documented in the literature. Its nonspecific signs and symptoms, such as redness, eye pain, and decreased vision, combined with the absence of established diagnostic and treatment guidelines, make its recognition in this age group challenging. We report a case of a 33-day-old infant diagnosed with HSV-2–associated ARN, incidentally identified during retinopathy of prematurity screening. The diagnosis was confirmed through characteristic clinical findings and positive serum HSV-2 testing. Prompt antiviral treatment yielded favorable clinical outcomes. Notably, this case demonstrated bilateral macular scars and corneal scarring, both rarely reported in neonatal ARN. Conclusions: This case, along with a review of the literature, expands the understanding of ARN in neonates and underscores the importance of early recognition and timely antiviral therapy to optimize visual outcomes.