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Cytomegalovirus retinitis in the absence of HIV or immunosuppression

Sloan, D. J., Taegtmeyer, Miriam ORCID: https://orcid.org/0000-0002-5377-2536, Pearce, I. A., Hart, I. J., Miller, A. R. O. and Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791 (2008) 'Cytomegalovirus retinitis in the absence of HIV or immunosuppression'. European Journal of Ophthalmology, Vol 18, Issue 5, pp. 813-815.

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Abstract

PURPOSE. Cytomegalovirus (CMV) retinitis classically occurs in advanced human immunodeficiency virus (HIV) infection but is rare in other forms of immunosuppression. The authors report a case of CMV retinitis in an HIV-negative man with idiopathic CD4 lymphocytopenia (ICL). This is the first such case to be confirmed by polymerase chain reaction (PCR) of aqueous humor.
METHODS. Case report.
RESULTS. A 69-year-old retired Chinese seaman presented with gradual visual deterioration. He was a diet controlled diabetic on regular steroids for presumed asthma. Examination showed no diabetic eye disease but confirmed acute retinal necrosis (ARN). Anterior chamber tapping of the aqueous humor was PCR positive for CMV. HIV antibody and RNA tests were negative but his full blood count revealed lymphocytopenia, with a low CD4+ subset. He responded to a 3-week course of intravenous ganciclovir therapy followed by suppressive oral valganciclovir.
CONCLUSIONS. CMV is associated with sight-threatening retinitis in HIV infection at CD4+ counts below 50 cells/mu L and in transplant recipients or heavily immunosuppressed patients. Systemic steroids are a risk factor for clinical disease in these groups. It is extremely rare to report CMV eye disease in previously healthy individuals. This case illustrates that the condition does occur in association with ICL. Corticosteroids may be implicated in disease reactivation. Molecular methods are necessary to confirm the diagnosis. (Eur J Ophthalmol 2008; 18: 813-5)

Item Type: Article
Uncontrolled Keywords: cytomegalovirus retinitis hiv negative cd4 lymphocytopenia corticosteroids patient
Subjects: WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WW Ophthalmology > Diseases. Color Perception > WW 140 Eye diseases
WW Ophthalmology > Eye Structures and their Diseases > WW 270 Retina
Faculty: Department: Groups (2002 - 2012) > Clinical Group
Depositing User: Users 43 not found.
Date Deposited: 24 Aug 2010 09:29
Last Modified: 06 Feb 2018 13:00
URI: http://archive.lstmed.ac.uk/id/eprint/923

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