First Author: C.Nazar CHILE
Co Author(s): M. Astete A. Munoz
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To describe a case of bilateral Cytomegalovirus Retinitis in a patient with Crohn's disease, who received therapy with anti-tumour necrosis factor alpha antibody (anti-TNF-alpha).
Report of a case evaluated at Department of Ophthalmology of the Clinical Hospital of the Pontificia Universidad Católica de Chile, Santiago, Chile.
Review of the medical records of a case with diagnosis of cytomegalovirus retinitis in a patient with Crohn's disease, refractory to treatment with corticosteroids. Informed consent was obtained. Review of current literature.
A 44-year old Chilean woman with Crohn's disease, refractory to treatment with corticosteroids, and poor response to Azathioprine and anti-TNF-alpha antibodies, that required high doses of Infliximab. After six months of treatment, presented with diarrhea and vision loss in her left eye. On examination, her best corrected visual acuity (BCVA) was 0.9 and counting fingers in right and left eye, respectively. The fundoscopic exam revealed extense white granular retinal infiltrates and retinal haemorrhages in the posterior pole in the left eye. Laboratory exams showed Cytomegalovirus Polymerase chain reaction in blood: >9 million UI/mL. The patient was treated with intravenous Ganciclovir, followed by oral Valganciclovir and received 3 intravitreal ganciclovir injection in the left eye, resulting in ophthalmologic remission. At 4 month follow up, the patient has no recurrence signs and BCVA: 0.05 in left eye
To the best of our knowledge, this is the first reported case of cytomegalovirus retinis in patient with Crohn's disease treated with anti-TNF-alpha antibodies. This diagnose should be considered if visual symptoms are present.