CMV retinitis after cessation of ganciclovir therapy for CMV antigenemia in an unrelated BMT recipient

Abstract

Summary:An 11-year-old boy with severe aplastic anemia underwent unrelated BMT following TBI, antithymocyte globulin and CY. On day +23, CMV antigenemia was detected which resolved with ganciclovir. Eight days after discontinuing ganciclovir, he complained of impaired visual acuity. Ophthalmologic findings and a positive PCR study using anterior chamber fluid from the right eye confirmed the presumptive diagnosis of CMV retinitis, although CMV antigenemia and PCR studies using PBMC were then negative. He was successfully re-treated with ganciclovir. CMV retinitis should be considered even when CMV antigenemia is not present or PCR using PBMC is negative.

CMV retinitis after allogeneic bone marrow transplantation: a report of five cases

“…CMV retinitis has previously been described only as single case reports after SCT (11–13). A larger study was presented in 2001 from the Seattle Group (4).…”

Management of relapsing cytomegalovirus disease in transplant recipients: diagnostic and therapeutic dilemmas

“…As in our case, the diagnosis of retinitis in transplant recipients is frequently obtained only when symptoms prompt ophthalmoscopy: an elevated clinical suspicion is therefore warranted to allow early diagnosis and timely treatment, and periodic ophthalmologic assessment of asymptomatic patients has been suggested post‐transplantation (4–6). On the other hand, virologic monitoring techniques (antigenemia, culture, gene amplification) have significant limitations when retinitis is suspected (as described in our patient and in recently published reports in the literature) (8, 9).…”