First Author: I.Garcia-Basterra SPAIN
Co Author(s): N. Rachwani R. Bosch A. Garcia-Ben
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To report a case of cytomegalovirus (CMV) retinitis in an immunosuppressed patient affected with peripheral T-cell lymphoma and rheumatoid arthritis.
University Hospital Virgen de la Victoria, Málaga, Spain.
A 65 year-old man diagnosed with Peripheral T-cell lymphoma and rheumatoid arthritis was referred to our Retinal Unit due to eye floaters in his right eye. The patient received chemotherapy 18 months before presentation. In his right eye, his best-corrected visual acuity (BCVA) and intraocular pressure were 0.8 and 16 mmHg respectively. Slit lamp examination revealed tyndall and funduscopy showed moderate vitritis, intraretinal and superotemporal perivascular haemorrhages and inferior retinal ischaemia. CMV DNA in plasma was detected using polymerase chain reaction (PCR) test.
The patient was treated with intravenous Ganciclovir during 21 days and continued with oral valganciclovir during 1 year. The viral load was undetectable after 2 weeks of treatment. At 3 months of follow-up the retinal haemorrhages reabsorbed and peripheral retinal atrophy appeared.
CMV is a common cause of morbidity and mortality in immunocompromised patients such as those with AIDS, haematological diseases and transplant recipients on immunosuppressive therapy. Local ocular immunosuppression has been demonstrated as a risk factor for CMV retinitis, and there have also been cases of retinitis in the absence of immunosuppression. Diagnosis is based on history, retinal findings and an immunosuppressive condition. PCR analysis of the vitreous, aqueous or blood should be tested to support the diagnosis. Management is based on intravenous, oral, and intravitreal antiviral medications depending on the severity and response. Oral valganciclovir can be used for long-term therapy instead of intravitreal or intravenous therapy. Ophthalmologist and internist should be aware of this possible presentation in immunosuppressed patient other than AIDS to ensure a certain diagnosis and a close follow-up.