Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Zhao, Ning; Liu, Lei; Xu, Junjie

doi:10.1097/md.0000000000006878

Cited by 4 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ophthalmologic findings consistent with CMV retinitis include areas of white/pale necrotic retina and focal areas of hemorrhage spreading centrifugally along vascular arcades (98). Treatment includes systemic antiviral therapy and/ or intravitreal injections of antivirals (99)(100)(101).…”

Section: Case Discussionmentioning

confidence: 99%

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

et al. 2022

View full text Add to dashboard Cite

Cytomegalovirus (CMV), like other herpesviruses, has the unique ability to establish latent infection with subsequent reactivation during periods of stress and immunosuppression. Herpesviruses cause potentially devastating disease, particularly in hematopoietic stem cell transplant (HSCT) recipients. CMV is especially of concern in HSCT recipients given the high community seroprevalence, high risk of reactivation and high risk of transmission from HSCT donors to recipients causing primary infection after transplantation. The risk of CMV infection and severity of CMV disease varies depending on the underlying disease of the HSCT recipient, donor and recipient CMV status prior to HSCT, type of conditioning therapy in preparation for HSCT, allogeneic versus autologous HSCT, donor graft source, timing of infection in relation to HSCT, and other patient comorbidities. Different strategies exist for prevention (e.g., preemptive therapy vs. universal prophylaxis) as well as management of CMV disease (e.g., antiviral therapy, augmenting immune reconstitution, cytotoxic T-cell therapy). The purpose of this narrative review is to discuss diagnosis, prevention, and management of CMV infection and disease at different stages of HSCT, including key points illustrated through presentations of complex cases and difficult clinical scenarios. Traditional and novel strategies for CMV management will be discussed in the context of these unique clinical cases.

show abstract

Section: Case Discussionmentioning

confidence: 99%

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Overall, GCV or Foscarnet represent the most widely used systemic therapies for CMVR. 2 , 7 – 10 , 12 , 18 Only a few patients have been treated with intravitreal injection of GCV ( Table 1 ). Larsson et al described two patients who received combined systemic and local treatment with intravitreal injections of GCV, 12 while Zhang et al described 12 patients who received combined systemic and intravitreal injection 16 ; 11 eyes showed improvements or stabilization whereas 8 eyes deteriorated.…”

Section: Discussionmentioning

confidence: 99%

CMV retinitis in a stem cell transplant recipient treated with foscarnet intravitreal injection and CMV specific immunoglobulins

Vassallo

Nuzzi

Cattani

et al. 2020

Therapeutic Advances in Hematology

View full text Add to dashboard Cite

Cytomegalovirus (CMV) retinitis (CMVR) has been reported rarely in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). In addition, little is known about strategies for ophthalmic surveillance and adequate antiviral treatment of CMVR. A case of CMVR in an allogeneic HSCT recipient is described, including clinical signs and therapy. An adult patient received HSCT from a matched unrelated donor for treatment of a Burkitt lymphoma. Donor and recipients were both CMV positive. Starting on day +40, the patient presented multiple CMV reactivation, treated with valganciclovir, foscarnet and a combination of both. On day +160, the patient started complaining of conjunctival hyperaemia and a decrease in visual acuity. Fundoscopy revealed retinal lesions consistent with CMVR, although whole blood CMV DNAemia was negative. Aqueous humor biopsy showed the presence of CMV infection (CMV DNA 230400 UI/ml). CMVR was treated with foscarnet (180 mg i.v. and 1.2 mg intravitreal injection) combined with anti CMV immunoglobulin at 0.5 ml/kg every 2 weeks. After 4 weeks of systemic therapy, 20 weekly doses of intravitreal foscarnet and six cycles of immunoglobulins, a significant improvement of visual acuity was observed. The treatment was well tolerated with no side effect. In conclusion, our case suggests that systemic and local antiviral treatment combined with CMV-specific-IVIG, may reduce CMV load in the eye of patients with CMVR, leading to a consistent improvement of visual acuity. Systematic ophthalmologic examination should be recommended in HSCT recipients with multiple CMV reactivations and high peak CMV DNA levels.

show abstract

“…When clinical feature shows no significant evidence of CMVR, laboratory examination is needed. [6] On the one hand, CMV-IgM from the blood is the diagnostic index normally used for HCMV infection at present. [7] However, for ALL patients who receive chemotherapy, their immunity has been impaired.…”

mentioning

confidence: 99%

CD4+ cells as a potential biomarker for cytomegalovirus retinitis in children with acute lymphocytic leukemia

Wang

et al. 2019

Chinese Medical Journal

View full text Add to dashboard Cite

Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Cited by 4 publications

References 15 publications

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

Prevention and management of human cytomegalovirus in pediatric HSCT recipients: A review

CMV retinitis in a stem cell transplant recipient treated with foscarnet intravitreal injection and CMV specific immunoglobulins

CD4+ cells as a potential biomarker for cytomegalovirus retinitis in children with acute lymphocytic leukemia

Contact Info

Product

Resources

About