Cytomegalovirus Retinitis in an Immunocompromised Infant:A Case Report and Review of the Literature

Abstract

Purpose: To describe a case of bilateral cytomegalovirus retinitis (CMVR) in an immunocompromised infant. Methods: A 4-month-old male infant with severe combined immunodeficiency syndrome was examined for the presence of CMVR. Ocular involvement was recorded and monitored by digital imaging. Results: The child had bilateral CMVR, with a fine granular pattern, present both in the peripheral retina and posterior pole. There was no vitritis. The active areas of retinitis progressively resolved with intravenous ganciclovir treatment. At the 3-month follow-up examination, no recurrence was observed. Conclusion: Ganciclovir treatment was effective in this case. The prognosis depends on rapid institution of effective antiviral therapy and on a patient’s systemic immunocompetence.

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

“…These factors along with a more aggressive nature of retinitis and tendency towards bilateral involvement pose a serious risk of irreversible blindness warranting special attention and prompt initiation of treatment (Mota et al 2011;Singh et al 2012). These factors along with a more aggressive nature of retinitis and tendency towards bilateral involvement pose a serious risk of irreversible blindness warranting special attention and prompt initiation of treatment (Mota et al 2011;Singh et al 2012).…”

“…Furthermore, systemic testing methods for CMV are routinely used to monitor patients for reactivation and response to treatment in the haematological settings. There are other centres reporting confirmation of CMVR based on systemic testing (Mota et al 2011;Jeon et al 2012;Kobayashi et al 2012;Davis et al 2013;Samia et al 2014;Iu et al 2016). There are other centres reporting confirmation of CMVR based on systemic testing (Mota et al 2011;Jeon et al 2012;Kobayashi et al 2012;Davis et al 2013;Samia et al 2014;Iu et al 2016).…”

Bilateral cytomegalovirus retinitis in a healthy infant

“…The pattern of congenital CMVR differs from the acquired adult type, and the fundus manifestations may vary from subtle white flecks to more florid presentations with white infiltrates (accompanied by hemorrhage). Overall, congenital CMV is typically less hemorrhagic and less progressive than the acquired type in immunocompromised children 7, 8. Surprisingly, the presentation of this hemorrhagic case was suggestive of a postnatally-acquired infection rather than a congenitally perinatal infection.…”

“…The survivors often suffer from long-term sequelae such as cerebral palsy, developmental delays, hearing loss, epilepsy, ocular abnormalities, and microcephaly. Also, the clinical manifestations of intrauterine infection include hepatosplenomegaly, jaundice, thrombocytopenia, periventricular calcification, and chorioretinitis 3, 7, 8…”

“…Besides AIDS and human immunodeficiency virus (HIV), other immunosuppressive conditions such as severe combined immunodeficiency are associated with CMVR in children. Moreover, this infection has been reported in patients undergoing bone marrow transplants and chemotherapy 7, 8. Surprisingly, CMVR has been detected in individuals without any evidence of immunodeficiency 9, 10…”