Juxtapapillary Cytomegalovirus Retinitis With Optic Neuritis

Abstract

A 49-year-old man with AIDS developed acute monocular visual loss and an ipsilateral swollen optic disc with a large right relative afferent pupillary defect, a nerve fiber bundle visual field defect, and a peripapillary retinal infiltrate. Lumbar puncture disclosed cytomegalovirus (CMV) DNA on polymerase chain reaction (PCR). Treatment with oral valganciclovir produced complete resolution of the visual deficits and the fundus abnormality. This case differs from previously reported cases of CMV optic neuritis in which visual function has been irreversibly lost.

Infectious optic neuropathies: a clinical update

“…Several cases of CMV optic neuropathy in immune-compromised patients unrelated to CMV retinitis have also been described, including isolated optic neuritis, retrobulbar optic neuritis associated with meningoencephalitis and bilateral PORN, and bilateral retrobulbar optic neuritis following haploidentical hematopoietic stem cell transplantation 31–35. A few cases of bilateral CMV papillitis without associated retinitis have been reported in young immunocompetent patients, with good recovery after antiviral therapy with or without associated corticosteroid therapy 36–38.…”

The neuro-ophthalmology of HIV-AIDS review of Neurobehavioral HIV Medicine

“…60 Treatment includes high doses of intravenous foscarnet and/or gancyclovir 63 and also with oral valgancyclovir. 64 Treatment should be initiated early before the development of optic atrophy.…”

Cytomegalovirus and Eye

“…At the end of this study, 65% of patients would have preferred to receive postoperative ocular protection. 4 Another study 5 also reported that patching could modulate inflammation and aid in wound healing.…”

“…CMV affects the optic nerve from an adjacent focus of peripapillary CMV retinitis and, concomitantly, peripheral foci of CMV retinitis may be noted. 4,5 Oral valganciclovir has proven to be a new and highly efficacious alternative to the chronic administration of ganciclovir in patients with CMV retinitis. In addition to its excellent bioavailability and favourable pharmacokinetic profile, valganciclovir has also proved to be cost effective and is the most widely used drug in the armamentarium for the treatment of CMV retinitis.…”

“…Also reported in the literature is CMV-related optic neuritis. 4,5 CMV optic neuritis is a rapidly-blinding disease. CMV affects the optic nerve from an adjacent focus of peripapillary CMV retinitis and, concomitantly, peripheral foci of CMV retinitis may be noted.…”