Cytomegalovirus Retinitis in Immunocompetent Patients: Case Reports and Literature Review

Radwan, Alaa; Metzinger, Jamie Lynne; Hinkle, David M.; Foster, C. Stephen

doi:10.3109/09273948.2013.786095

Cited by 33 publications

(23 citation statements)

References 17 publications

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“…Among these reports, the gastrointestinal [5][6][7] and respiratory tract [8], as well as central nervous system [3], were the most frequent sites of severe CMV infection. Other manifestations included hematological disorders (hemolytic anemia and thrombocytopenia) [9,10], thrombosis of the venous or arterial vasculature [11] and ocular involvement [12]. In contrast to those reports, our patient presented with an unusual clinical scenario of important multisystemic involvement, namely hematological, neurological, enteric and respiratory.…”

Section: Discussioncontrasting

confidence: 48%

Cytomegalic Infection in an Immunocompetent Patient: A Case With Multiple Organ Dysfunction

Urbano¹,

Moreira-Silva²,

Friões

et al. 2015

J Med Cases

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Cytomegalic infection of the immunocompetent adult is usually asymptomatic or expressed by a mononucleosic syndrome. We present a case of a young adult with rare and severe primary cytomegalic infection and multisystemic involvement, namely hematological, hepatic, gastrointestinal and respiratory, including pneumonia with severe pulmonary hypertension, to the best of our knowledge, not previously described. Also of note is the fact that these dysfunctions were treated successfully with ganciclovir, although a formal indication to antivirals on cytomegalic infection of the immunocompetent patients is not established yet.

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Section: Discussioncontrasting

confidence: 48%

Cytomegalic Infection in an Immunocompetent Patient: A Case With Multiple Organ Dysfunction

Urbano¹,

Moreira-Silva²,

Friões

et al. 2015

J Med Cases

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“…5 ,6 Ocular toxoplasmosis may be acquired in utero (congenital) or postnatally and reactivation can occur with or without an immunocompromised state, whereas CMV retinitis rarely occurs in immunocompetent patients who are not receiv ing immunosuppressants. 7,8 In both of our patients, there was evidence for newly acquired infection: in case 1, baseline CMV serologic testing was negative, but became positive 15 months later when CMV retinitis was diagnosed; in case 2, recent infection was suggested by detection of serum IgM for T gondii. The cases described in the present report highlight the difficulty in differentiating AQP4-associated optic neuritis from opportunistic retinal infections and the importance of careful ophthalmologic evaluation …”

Section: Discussionmentioning

confidence: 99%

Opportunistic Infections of the Retina in Patients With Aquaporin-4 Antibody Disease

et al. 2014

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“…Endophthalmitis generally occurs postoperatively or traumatically, with endogenous endophthalmitis being a rare entity [12]. (3) CMV retinitis, which usually occurs in immunocompromised hosts, though there is some evidence for CMV retinitis in immunocompetent hosts [13]. CMV retinitis is usually described in pediatric patients with a link to lymphoma [14] or immunocompromised children.…”

Section: Case Presentationmentioning

confidence: 99%

Acute Retinal Necrosis in Childhood

Pikkel¹,

Pikkel²

2014

Case Rep Ophthalmol

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Background: Acute retinal necrosis (ARN) is a viral syndrome consisting of uveitis/vitritis, occlusive vasculitis and peripheral necrosis. Few incidents are reported in children. The etiology is reactivated herpes simplex virus (HSV) or varicella-zoster virus (VZV). Treatment with acyclovir is often used. The administration of oral glucocorticosteroids is of unproven benefit. Prognosis is variable but poor. Methods: Three weeks after contracting mild chickenpox, a healthy 4-year-old girl developed blurred vision in her right eye. Severely reduced visual acuity was noted, together with anterior uveitis, ‘mutton-fat' precipitates and vitral flare. Retinal vasculitis with necrosis was present. Serology for toxoplasma, cytomegalovirus and HIV was negative, while HSV and VZV IgG antibodies were positive. She was treated with 30 mg/kg of intravenous methylprednisolone (3 days), 30 mg of oral prednisone (3 days), and tapering for 8 weeks. Intravenous acyclovir was given for 10 days, followed by oral acyclovir for 4 months. Aspirin (100 mg/day) was given for 4 months. Results: At 12 months, the girl felt good. Her right eye acuity was 6/9, with an intraocular pressure of 17 mm Hg. The peripheral retina showed scarring but no detachment. Conclusions: This is the first report of a once-daily high-dose methylprednisolone pulse therapy in one of the youngest known ARN cases. Pulsed steroid therapy was based on its known effectiveness in vasculitis, which is the main pathophysiology in ARN. There was no evidence of steroid-related viral over-replication. Our case achieved an excellent clinical and ophthalmic recovery in spite of the poor prognosis. The positive result of this case report provides a basis for further evaluation of high-dose steroid pulse therapy in ARN.

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Cytomegalovirus Retinitis in Immunocompetent Patients: Case Reports and Literature Review

Abstract: The cases described herein serve to inform ophthalmologists of the urgent need to include CMV in their differential when encountering an immunocompetent adult with significant comorbidities or with a history of previous exposure. Proper treatment is heavily reliant on proper diagnosis.

Cited by 33 publications

References 17 publications

Cytomegalic Infection in an Immunocompetent Patient: A Case With Multiple Organ Dysfunction

Cytomegalic Infection in an Immunocompetent Patient: A Case With Multiple Organ Dysfunction

Opportunistic Infections of the Retina in Patients With Aquaporin-4 Antibody Disease

Acute Retinal Necrosis in Childhood

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