Kyrieleis plaques in cytomegalovirus retinitis

Abstract

PurposeThe purpose of this study is to report a case of Kyrieleis plaques (segmental retinal periarteritis) associated with cytomegalovirus (CMV) retinitis.MethodsA 47-year-old female with recently diagnosed human immunodeficiency virus and a CD4 count of 55 cells/µl presented with decreased vision and floaters in her left eye. Ophthalmic examination revealed an advancing border of white granular CMV retinitis extending into the macula. Intraocular aqueous specimen contained 420,000 copies/ml of CMV DNA by polymerase chain reaction. The patient was treated with intravitreal foscarnet and oral valganciclovir.ResultsKyrieleis plaques involving the retinal arteries were noted on presentation and increased during the first 6 weeks of treatment as the retinitis faded. The plaques on fluorescein angiography did not leak fluorescein dye and slowly faded over 5 months.ConclusionsKyrieleis plaques can be seen in the setting of CMV retinitis. These plaques can be differentiated from vascular sheathing and frosted branch angiitis by its occurrence only in the retinal arteries and the absence of leakage of fluorescein dye.

Kyrieleis plaques in herpes zoster virus-associated acute retinal necrosis: a case report

“…We also performed a case-control study to identify risk factors, as this is recognised as a valid methodology to identify possible risk factors for rare conditions. 2 Our conclusions regarding the use of subconjunctival anaesthesia are based on the analysis of 3 out of 47 PIAE cases compared with 1 out of 200 control cases receiving this anaesthesia. 3 Although this study reports one of the largest known series of PIAE, due to the relatively small number of patients with individual risk factors, it was not possible to fit our results to a multivariate model (as acknowledged in our paper).…”

“…1 They have been primarily described in association with infections of the retina, Toxoplasma gondii chorioretinitis being the most common. 2 Other described associated causes include cytomegalovirus (CMV) retinitis, syphilitic retinitis, acute retinal necrosis (ARN) due to Herpes Simplex Virus-2, Varicella-Zoster Virus, and Rickettsia conorii infections. [3][4][5] Orzalesi and Ricciardi 6 suggested they are an immune response, resulting from deposition of immune cells and inflammatory debris in arterial walls.…”

“…In eyes, GAG deposition results in: (i) glaucoma, (ii) retinal degeneration, (iii) corneal haze, and (iv) optic disc swelling or atrophy. 2 We report 13 children (Table 1) homozygous for L490P, treated with either haematopoietic stem cell transplantation (HSCT) or enzyme replacement therapy (ERT). This is the first report to correlate ocular phenotype and timing of treatment in a subset of MPS I patients with a defined mutation.…”

New appraisals of Kyrieleis plaques: a multimodal imaging study

“…Griffin and Bodian2 later used the term segmental retinal periarteritis to describe these changes, which appear as focal or segmental yellowish-white accumulations around retinal arteries, typically near or adjacent to an area of active retinal infection or inflammation. While Kyrieleis plaques are observed most often in eyes with active Toxoplasma gondii retinochoroiditis,3 they have also been reported with Rickettsia conorii , Mycobacterium tuberculosis , Treponema pallidum ,4 and varicella-zoster virus (VZV) and cytomegalovirus (CMV) infections 5 6…”

Cytomegalovirus Retinitis in the Post-cART Era

“…The frosted branch angiitis variant demonstrates late perivascular leakage or staining, or rarely perivascular hypofluorescence [44, 45]. Kyrieleis plaques may also be seen in CMVR and can be distinguished from frosted branch angiitis by the lack of perivascular leakage on FA [46]. FA may identify late complications of CMVR, including optic disc neovascularization, choroidal neovascularization and cystoid macular edema (CME) [47–49].…”