Virological, Clinical, and Ophthalmologic Features of Cytomegalovirus Retinitis after Hematopoietic Stem Cell Transplantation

Abstract

We identified 10 patients who developed cytomegalovirus (CMV) retinitis after HSCT during a 14-year period. The median day of diagnosis of CMV retinitis after transplantation was day 251 (range, days 106--365). CMV retinitis was associated with CMV serostatus of donor or recipient (P=0.01), CMV reactivation before day 100 (P=0.007), delayed lymphocyte engraftment (P<0.05), and chronic graft versus host disease (GVHD; P<0.001). In allogeneic recipients of HSCT who were alive at day 100 after transplantation and had chronic clinical extensive GVHD, the incidence of GVHD was 1.4% (8 of 577). Five of 10 patients had other manifestation of CMV disease before retinitis occurred (4 with gastrointestinal disease and 1 with interstitial pneumonia; median time, 70 days before onset of CMV retinitis; range, 58--279 days), and 4 others had CMV excretion. CMV retinitis was bilateral in 4 patients; 9 of 10 patients had ocular symptoms (i.e., decreased vision and floaters). Six of 7 patients responded well to ganciclovir or foscarnet systemic treatment, 1 improved only after switching to cidofovir, and 1 patient who received a transplant in 1983 did not respond to acyclovir treatment. In conclusion, CMV retinitis is an uncommon late complication after HSCT that occurs mainly in seropositive allograft recipients with previous CMV reactivation and chronic GVHD, and with delayed engraftment of lymphocytes.

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

“…Furthermore, especially relevant are the negative screening results for isolated lung involvement [8/12 episodes (66%) (7/9 in the pp65Ag vs 1/3 in the quantPCR period)] in comparison to only 4/12 (33%) episodes with isolated GI involvement. A higher rate of negative pp65Ag screening tests compared with quantPCR have been reported in cases of CMV colitis, retinitis or other localised non-pulmonary sites of CMV-D. 13,14,33,34 In fact, an advantage in preventing GI CMV-D has been reported with PCR screening techniques in comparison to antigenemia testing. 35 However, as most cases of CMV pneumonia with prior negative screening tests occurred during the pp65Ag screening period in this study, molecular screening methods could offer higher sensitivity over pp65Ag in detecting CMV replication before the occurrence of CMV pneumonia.…”

Cytomegalovirus in Hematopoietic Stem Cell Transplant Recipients

“…[59][60][61][62] Decreased visual acuity and blurred vision are early symptoms, and approximately 60% of patients have involvement of both eyes. 60 Untreated, the risk for loss of vision on the affected eye is high. Other manifestations including hepatitis and encephalitis do occur, but are rare.…”

“…60,[160][161][162] Fomivirsen is an antisense RNA molecule that targets mRNA encoded by CMV and is approved as second-line therapy for CMV retinitis in patients with AIDS. 163 Other manifestations of CMV disease, such as hepatitis and encephalitis, are uncommon and are typically managed with intravenous ganciclovir.…”

Lymphopenia and Treatment-Related Infectious Complications in ANCA-Associated Vasculitis

“…Neutropenia was defined by an absolute neutrophil count # 1.5310 9 /L (15). Moderate and severe lymphopenia were defined by an absolute lymphocyte count of 0.31-1.03 10 9 /L and #0.3310 9 /L, respectively (16,17). Finally, we assessed the use of Pneumocystis jiroveci prophylaxis.…”