Ganciclovir-Resistant Cytomegalovirus (CMV) Retinitis in a Patient with Wild-Type CMV in Her Plasma

Moss, Howard A.; Chavala, Sai H.; Say, Emil Anthony T.; Miller, Melissa B.

doi:10.1128/jcm.00029-12

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…In most instances, the more severe inflammation and vascular occlusion was ascribed to relative retention of anti-CMV immunoreactivity. However, other studies have failed to identify consistent difference in clinical presentation based on HIV status [ 18 – 20 , 24 , 26 , 30 – 33 , 37 – 40 , 44 , 94 , 95 ]. In our review, of all the reported cases to date of HIV-negative CMVR not associated with Good syndrome or following intraocular or periocular administration of corticosteroids, clinical features of the inflammation were reported in 199 of the 248 eyes (80.2 %).…”

Section: Reviewmentioning

confidence: 99%

Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Downes

Tarasewicz

Weisberg

et al. 2016

J Ophthal Inflamm Infect

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We describe a 65-year-old Thai woman who developed cytomegalovirus retinitis (CMVR) in the setting of Good syndrome—a rare, acquired partial immune deficiency caused by thymoma. The patient subsequently developed vitritis with cystoid macular edema (CME) similar to immune recovery uveitis (IRU) despite control of the retinitis with antiviral agents. A comprehensive review of the literature through December, 2014, identified an additional 279 eyes of 208 patients with CMVR in the absence of human immunodeficiency virus (HIV) infection. Including our newly reported case, 9 of the 208 patients (4.3 %) had Good syndrome. Twenty-one of the 208 patients (10.1 %) had CMVR related to intraocular or periocular corticosteroid administration. The remaining 178 patients (85.6 %) acquired CMVR from other causes. Within the subset of patients who did not have Good syndrome or did not acquire CMVR followed by intraocular or periocular corticosteroid administration, there were many other factors contributing to a decline in immune function. The most common included age over 60 years (33.1 %), an underlying malignancy (28.7 %), a systemic autoimmune disorder requiring systemic immunosuppression (19.1 %), organ (15.2 %) or bone marrow (16.3 %) transplantation requiring systemic immunosuppression, and diabetes mellitus (6.1 %). Only 4.5 % of the patients had no identifiable contributor to a decline in immune function. While the clinical features of CMVR are generally similar in HIV-negative and HIV-positive patients, the rates of moderate to severe intraocular inflammation and of occlusive retinal vasculitis appear to be higher in HIV-negative patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12348-016-0070-7) contains supplementary material, which is available to authorized users.

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Section: Reviewmentioning

confidence: 99%

Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Downes

Tarasewicz

Weisberg

et al. 2016

J Ophthal Inflamm Infect

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“…A 39-year-old female with Burkitt's lymphoma on RHyperCVAD developed CMV retinitis and was treated with intravenous ganciclovir, intravitreal ganciclovir, and intravenous foscarnet. [5] Another 50-year-old man with T-cell ALL developed CMV retinitis during 4 th cycle of R HyperCVAD and was treated with oral valganciclovir. [6] A 49-year-old man with ALL, on salvage chemotherapy with HyperCVAD, developed CMV retinitis and was treated with intravenous ganciclovir with preservation of visual acuity.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus retinitis occurring as a complication of HyperCVAD chemotherapy: Report of two cases

Narayanan

Haridas

Soman

2018

Indian J Med Paediatr Oncol

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Cytomegalovirus (CMV) retinitis is usually diagnosed in patients with acquired immunodeficiency syndrome and in solid organ and hematopoietic stem cell transplant recipients. It produces a characteristic necrotizing retinitis which is a sight-threatening condition in these patients. CMV retinitis occurs rarely in patients undergoing only chemotherapy, and very few cases have been reported during the maintenance phase of acute lymphoblastic leukemia (ALL) in children. We report two patients, one with ALL and the other with Burkitt’s lymphoma on HyperCVAD chemotherapy developing CMV retinitis during the course of treatment. Both patients were treated with intravenous ganciclovir, oral valganciclovir and intravitreal ganciclovir. Both patients are alive in remission at 60 and 40 months, respectively, with preservation of normal vision.

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“…First‐line therapy is IV ganciclovir or its prodrug valganciclovir which can be given orally and has comparable efficacy . In cases that are refractory to ganciclovir or valganciclovir, or in those who are unable to tolerate them due to toxicity, IV foscarnet is recommended before IV cidofovir . Probenecid pre‐ and post‐infusion of cidofovir is required for nephroprotection.…”

Section: Treatmentmentioning

confidence: 99%

“…131,[135][136][137] In cases that are refractory to ganciclovir or valganciclovir, or in those who are unable to tolerate them due to toxicity, IV foscarnet is recommended before IV cidofovir. 137,138 Probenecid pre-and post-infusion of cidofovir is required for nephroprotection. Cidofovir can also cause hypotony in the presence of a ganciclovir implant.…”

Section: Treatmentmentioning

confidence: 99%

Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review

Lightman

Tomkins-Netzer

2019

Clinical Exper Ophthalmology

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Necrotising retinitis is a rare ocular infection that historically led to high rates of visual morbidity. While acute retinal necrosis occurs in immunocompetent patients, the majority of cases are associated with immunocompromise such as in cytomegalovirus retinitis and progressive outer retinal necrosis. This review summarises the clinical and diagnostic features, management, and outcomes of herpetic retinitis. Iatrogenic immunosuppression is increasingly being utilised for a wide range of indications, and biologic agents especially so due to their targeted nature. While the intended actions are well‐studied, the flow‐on effects and complex interaction with host immunity are not well understood. Furthermore, biologics are frequently used concomitantly with other immunosuppressive agents, potentiating the immunodepression. This article reviews the literature on biologic immunosuppression and viral retinitis, and presents an approach to the vulnerable or affected patient. Early identification, prompt and aggressive treatment, and a multidisciplinary approach to managing immunodeficiency are the cornerstones of management.

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Ganciclovir-Resistant Cytomegalovirus (CMV) Retinitis in a Patient with Wild-Type CMV in Her Plasma

Cited by 8 publications

References 15 publications

Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Good syndrome and other causes of cytomegalovirus retinitis in HIV-negative patients—case report and comprehensive review of the literature

Cytomegalovirus retinitis occurring as a complication of HyperCVAD chemotherapy: Report of two cases

Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review

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