Purpose:This study aimed to describe an atypical case of acute retinal necrosis presenting with primary choroidal involvement and early development of rhegmatogenous retinal detachment.Case summary: A 67-year-old immunocompetent woman presented with blurred vision in the right eye. Fundus examination revealed multiple yellowish retinal infiltrations, perivascular sheathing, and hemorrhages in the inferotemporal quadrant. Fluorescein angiography indicated diffuse leakage and obstructive vasculopathy. Moreover, indocyanine green angiography revealed a scattering pattern of hypofluorescence focused in the inferotemporal quadrant. This differed from the results of fundus examination and fluorescein angiography, which were indicative of primary choroidal inflammation. Despite treatment, the patient developed retinal detachment within 4 weeks.Surgical intervention revealed that the area of choroidal infiltration remained attached, whereas the other retinal regions were detached.Postoperative imaging revealed the absence of previously hypofluorescent areas, indicative of choroidal inflammation.

Conclusions:This case highlights the importance of recognizing primary choroidal involvement in acute retinal necrosis as it can indicate a more severe disease course and lead to earlier complications such as rhegmatogenous retinal detachment. Thus, comprehensive imaging and timely intervention are critical for effective management of these patients.