[Cytomegalovirus retinitis in immunocompetent patients].
ABSTRACT Cytomegalovirus (CMV) retinitis usually affects severely immunosuppressed individuals. We report two immunocompetent patients who developed CMV retinitis.
Case 1 was a 65-year-old man who was referred to us with blurred vision and floaters of 2 weeks duration in his left eye. Slit-lamp biomicroscopy showed keratic precipitates, aqueous cells, and vitreous opacity in his left eye. Funduscopic examination revealed yellow-white retinal lesions with arterial sheathing in the superotemporal midperiphery. Case 2 was a 63-year-old man who presented with a 2-week history of blurred vision in his left eye. Ophthalmologic examination of the left eye showed keratic precipitates, aqueous cells, vitreous opacity, and yellow-white lesions in the superotemporal peripheral retina. In both cases, CMV DNA was detected in the aqueous humor and therefore the diagnosis was CMV retinitis. CMV retinitis in both cases was indolent and was resolved in one month without treatment with antiviral drugs. Although both patients had diabetes mellitus, the results of their laboratory examinations were unremarkable and they were immunocompetent.
Unlike CMV retinitis in immunocompromised patients, CMV retinitis in immunocompetent patients had significant anterior and vitreous inflammation but did not require antiviral treatment. A possible association between CMV retinitis and diabetes mellitus was suggested.
SourceAvailable from: Hitoshi Tabuchi[Show abstract] [Hide abstract]
ABSTRACT: We report a case of cytomegalovirus (CMV) retinitis in an immunocompetent patient who was resistant to antiviral treatment, and in whom fatal metastatic liver cancer was later detected. A 74-year-old Japanese man visited our ophthalmology clinic in May 2011. He had a history of well controlled type 2 diabetes and colon cancer, and underwent successful surgical treatment in 2008. In April 2011, he was diagnosed with uveitis affecting his left eye and received posterior sub-Tenon injection of triamcinolone acetonide. He was referred to us because of aggravation of the retinal lesion. Funduscopic examination of the left eye revealed arcuate, whitish, necrotizing retinitis with hemorrhage along the temporal arcade of the retina. Polymerase chain reaction of the aqueous fluid was positive for CMV DNA. Because of diagnosis of CMV retinitis in his left eye, he was referred to an internist and investigated for systemic CMV infection or any serious disease which could cause immunocompromise, but neither was detected. Despite an intensive course of intravitreous ganciclovir and oral valganciclovir, the retinitis did not resolve. In June 2012, 14 months after the initial ocular symptoms, metastatic liver cancer was found and the patient passed away. When CMV retinitis is resistant to antiviral treatment or recurs in an immunocompetent patient, it is important that ophthalmologists undertake systemic investigation for occult malignancy.Clinical ophthalmology (Auckland, N.Z.) 01/2013; 7:411-5. DOI:10.2147/OPTH.S41361
[Show abstract] [Hide abstract]
ABSTRACT: We sought to investigate and describe the clinical spectrum of posterior segment abnormalities in immunocompetent patients presenting with CMV-associated anterior uveitis. This was a prospective study conducted at the Singapore National Eye Centre, a tertiary referral centre, from August 2010 to June 2011. Eleven eyes of eleven patients with CMV anterior uveitis confirmed by polymerase chain reaction on aqueous humor sampling were recruited based on the study criteria. Patients were recruited from a single uveitis specialist clinic and underwent aqueous humor sampling and fluorescein and indocyanine green angiography as well as optical coherence tomography. They were further evaluated by the Infectious Disease physician for immunocompetence. Mean presenting visual acuity was logMAR 0.35 +/- 0.29. The main presenting complaints were blurring of vision, eye redness, and pain. Anterior chamber cellular activity was present in all cases. Fine diffuse keratic precipitates (KPs) were present in 10 eyes, and the remaining one eye had mutton fat KPs. Iris changes were present in three eyes. Intraocular pressure (IOP) was elevated in nine eyes (mean presenting IOP was 40.2 +/- 16.8 mmHg). In the posterior segment, none of the eyes had evidence of retinitis or hemorrhage. Posterior segment abnormalities were present in six eyes (macular edema, disc leakage, epiretinal membrane, phlebitis). Eight eyes also had prolonged arm to retina time (mean 24.8 +/- 10.6 s) on fluorescein angiography. Indocyanine green angiography was unremarkable. Posterior segment manifestations can be seen in a proportion of immunocompetent patients with CMV anterior uveitis. The underlying mechanism remains to be determined.Albrecht von Graæes Archiv für Ophthalmologie 07/2014; 252(11). DOI:10.1007/s00417-014-2743-y · 2.33 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Purpose: The purpose of this study was to examine 2 cases of cytomegalovirus (CMV) retinitis, occuring in 2 immunocompentent adult patients. Methods: Case selection and literature review. Results: Both patients cited significantly decreased vision despite systemic, topical, and/or local corticosteroid use. Neither patient was using high-dose immunosuppressant therapy at the time of diagnostic testing. Both patients exhibited confirmed CMV infection via polymerase chain reaction DNA testing. Oral antivirals were employed and have stabilized both patients. Conclusion: The cases described herein serve to inform ophthalmologists of the urgent need to include CMV in their differential when encountering an immunocompetent adult with significant comorbidities or with a history of previous exposure. Proper treatment is heavily reliant on proper diagnosis.Ocular immunology and inflammation 05/2013; 21(4). DOI:10.3109/09273948.2013.786095 · 0.72 Impact Factor