Brivudine

Acute retinal necrosis (ARN) is a sight-threatening ophthalmic emergency that requires aggressive treatment to prevent irreversible vision loss. However, primary treatment failure (PTF), where the initial antiviral therapy is ineffective, is a common challenge in ARN management. This comprehensive review examines PTF in ARN, drawing insights from a systematic literature search spanning 1997 to 2022, which identified 35 relevant cases from 23 reports. The analysis focuses on drug resistance patterns, alternative antiviral agents, combination therapies, and emerging treatments. Potential causes of drug resistance, including host factors, viral mutations, and drug-related considerations, are elucidated. Alternative agents such as foscarnet, cidofovir, and brivudine, as well as combination approaches involving systemic and intravitreal administration, high-dose therapy, judicious use of steroids, and potential treatment-related complications, are discussed. The review also highlights emerging therapies, including vaccines, monoclonal antibodies, and natural compounds, offering insights into future directions for addressing this challenging condition.

Herpes zoster (HZ), caused by the reactivation of the varicella-zoster virus (VZV), typically presents as a unilateral vesicular rash in a dermatomal pattern. Its occurrence in the genital area is rare and often misdiagnosed. We report the case of a 51-year-old woman who presented with sudden vulvar pain and burning, without a history of immunodeficiency or sexually transmitted infections. Examination revealed unilateral vesicular lesions on the left labium majus, perianal area, medial thigh, and gluteal region along the second sacral (S2) and third sacral (S3) dermatomes. Polymerase chain reaction (PCR) confirmed VZV and ruled out herpes simplex virus (HSV). The patient was treated with brivudine, mupirocin, and analgesics, resulting in a complete resolution of symptoms. This case highlights the need to consider HZ in the differential diagnosis of genital lesions. Early recognition and treatment of atypical presentations can prevent complications and improve patient outcomes.