A primary VZV infection complicated by retinitis in an immunocompetent child

Chickenpox, a primary infection caused by the varicella-zoster virus (VZV), is generally a mild childhood illness in immunocompetent children. Ocular complications during the primary infection remain rare. We report the case of a 10-year-old girl, with no medical history, who presented with unilateral decreased visual acuity one week after a clinically confirmed episode of chickenpox. The ophthalmological examination revealed a vitreous Tyndall effect associated with macular reorganization. The macular OCT showed hyperreflectivity of the photoreceptors with localized serous retinal detachment. The etiological assessment ruled out other infectious or inflammatory causes, and the VZV serology was positive (IgM and IgG). A treatment combining oral acyclovir, azithromycin, and deferred systemic corticosteroids was initiated, with a progressively favorable outcome, marked by the disappearance of the serous retinal detachment and visual recovery to 8/10 after one month. This case illustrates the possibility of retinal involvement during a primary VZV infection in an immunocompetent child and highlights the importance of early diagnosis and appropriate management to prevent visual sequelae.