Retinal ghost in a patient with Behçet's disease and positive cytomegalovirus PCR in the vitreous sample

Abstract

Purpose To document a case involving a patient previously diagnosed with Behçet's disease which proved unresponsive to multiple immunomodulatory therapies, and was subsequently diagnosed with secondary cytomegalovirus retinitis and appropriately treated. Methods This is a case report focused on the images. Results A 39-year-old female, previously diagnosed with Behçet's disease unresponsive to multiple immunomodulatory therapies, sought a second opinion at our clinic due to more floaters and a scotoma in her left eye for a few months. Her right eye had become blind as a result of multiple glaucoma and vitreoretinal surgeries. Her best corrected visual acuity was 20/60 in the left eye. A Slit lam examination of the left eye showed 1+ cells and flare in the anterior chamber along with 1+ cells in the anterior vitreous with no vitreous haze. Dilated fundoscopy of the left eye reveled an atrophic lesion in the inferior macula. Fluorescein angiography demonstrated a mixed hypo- and hyperfluorescent lesion in the left eye. Optical coherence tomography macula demonstrated an atrophic lesion in the inferior macula of the left eye. All laboratory findings were predominantly negative or within the normal range, except for the presence of antibodies to VZV and CMV in the blood. Polymerase chain reaction analysis of the vitreous sample uncovered the presence of CMV, leading to appropriate curative and prophylactic treatment for the patient. Conclusions and importance In patients with resistant noninfectious uveitis, particularly those experiencing underlying disease reactivation, the possibility of infections, especially opportunistic ones, should be taken into consideration.