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Kouzo Harimoto, Shou Ishikawa, HIsashi Watanabe, Sunao Sugita, Manabu Ogawa, Masaru Takeuchi; A Case of Cytomegalovirus-mediated Bilateral Retinal Necrosis. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2787.
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© ARVO (1962-2015); The Authors (2016-present)
Although varicella zoster virus (VZV) and herpes simplex virus (HSV) are well known causes of acute retinal necrosis (ARN), cytomegalovirus (CMV) is a rare etiology. We report a case of bilateral ARN (BARN) caused by CMV infection after chemotherapy for malignant lymphoma.
A 72-year-old man presented to our hospital with acute blurred vision in both eyes. He was diagnosed with malignant lymphoma and had been treated with R-CHOP therapy since 2008, but his hematologic tests were normal with white blood cell count of 4,400, comprising 62.7% neutrophils and 32.1% lymphocytes.At the initial ophthalmic examination, his best-corrected visual acuity (BCVA) was 20/200 in the right and 80/200 in the left eye, and intraocular pressure was 8 mmHg in both eyes. Mutton-fat keratic precipitates and infiltrating cells were observed in the anterior chamber bilaterally, especially marked in the right eye. Fundus examination showed diffuse vitreous opacity, circumferential yellowish-white exudates with retinal hemorrhages, retinal arteritis, and redness and swelling of the optic disk in his right eye. Similar lesions, although milder, were also observed in his left eye.
BARN was diagnosed. Acyclovir injection was initiated and vitrectomy was performed on the right eye 4 days later. However, multiplex PCR analysis from HHV1 to HHV8 using aqueous humor and vitreous fluid samples revealed only CMV with copy numbers of 2.91×106 and 6.5x106, respectively. Since CMV antigenemia test using blood sample was also positive, acyclovir injection was replaced with ganciclovir. After ganciclovir therapy, active lesions were gradually reduced and became atrophic. BCVA recovered to 0.3 in the right eye and 0.8 in the left eye.
After R-CHOP therapy, malignant lymphoma patient might develop CMV-mediated ARN, even though laboratory tests do not show abnormalities.
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