Cytomegalovirus retinitis and low-grade non-Hodgkin's lymphoma: Case report and review of the literature

Abstract

Patients with non-Hodgkin's lymphoma may develop retinal or choroidal lesions during the course of their disease. New immunosuppressive therapies currently used in reticuloendothelial malignancies have increased the incidence of opportunistic infections in this patient population. The differentiation of lymphomatous infiltration from opportunistic infection as a cause of chorioretinal infiltrates is critical, as the treatments are fundamentally different. We report a case of a patient with non-Hodgkin's lymphoma who developed a chorioretinal infiltrate that was initially thought to represent progressive disease. The patient received radiation treatment appropriate for intraocular lymphoma. The lesion progressed further and after reevaluation a diagnosis of cytomegalovirus retinitis was made and therapy initiated. Review of the literature for intraocular lymphoma and cytomegalovirus retinitis is provided and diagnostic strategies are described. We recommend analysis of intraocular fluid when there is difficulty in clinically differentiating intraocular lymphoma from opportunistic infection.

Atypical cytomegalovirus retinitis in non-Hodgkin's lymphoma

“…Vitreous fluid analysis showed atypical lymphoid elements, highly suspicious of malignancy, but PCR testing confirmed the presence of CMV in the vitreous. Derzko-Dzulynsky et al 3 also reported a case of a patient with NHL who developed a chorioretinal infiltrate that was initially difficult to differentiate between intraocular lymphoma and CMV infection, but the analysis of intraocular fluid helped in reaching a conclusive diagnosis. Nasir et al 4 reported a similar case of Hodgkin’s disease presenting with an atypical retinitis, vasculitis and a serous macular detachment.…”

A possible coincidence of cytomegalovirus retinitis and intraocular lymphoma in a patient with systemic non-Hodgkin’s lymphoma

“…The patient received radiation treatment appropriate for intraocular lymphoma. The lesion progressed further and after re-evaluation, which included vitreous fluid examination, a diagnosis of cytomegalovirus retinitis was made and therapy initiated [12]. Another case of a patient with follicular non-Hodgkin’s lymphoma and retinal infiltrate was described by Gooi et al .…”

Cytomegalovirus retinitis in HIV‐negative patients – associated conditions, clinical presentation, diagnostic methods and treatment strategy

“…Typically, confirmation of CMVR diagnosis can be achieved by obtaining an aqueous or vitreous sample, in which CMV may be detected by PCR (Fox et al 1991;Derzko-Dzulynsky et al 1998). It seems that centres are divided into their preference for either aqueous (24 centres) or vitreous tap (24 centres; see Tables S1 and S2).…”

“…Classically CMVR has been associated with AIDS, and before the advent of highly active retroviral therapy up to 40% of these patients were affected (Palestine et al 1984). Nevertheless, modern immunosuppressive therapies as well as improved survival rates have in recent years increased the incidence of opportunistic infections in other patient populations, and reports of CMVR in HIV-negative patients have been accumulating (Derzko-Dzulynsky et al 1998;Bertelmann et al 2005;Chawla et al 2005;Delyfer et al 2007;Sloan et al 2008;Jeon et al 2012;Bae et al 2013;Davis et al 2013;Gupta et al 2013;Radwan et al 2013;Samia et al 2014;Jeon & Lee 2015;Vishnevskia-Dai et al 2015;Downes et al 2016;Iu et al 2016;Karkhaneh et al 2016).…”