A possible coincidence of cytomegalovirus retinitis and intraocular lymphoma in a patient with systemic non-Hodgkin’s lymphoma

Abstract

PurposeTo present a possible coincidence of cytomegalovirus retinitis and intraocular lymphoma in a patient with systemic non-Hodgkin’s lymphoma.Case presentationA 47-year-old woman presented with decreased visual acuity associated with white retinal lesions in both eyes. A history of pneumonia of unknown aetiology closely preceded the deterioration of vision. Five years previously the patient was diagnosed with follicular non-Hodgkin’s lymphoma. She was treated with a chemotherapy regimen comprised of cyclophosphamide, adriamycin, vincristin, and prednisone with later addition of the anti-CD20 antibody rituximab. She experienced a relapse 19 months later with involvement of the retroperitoneal lymph nodes, and commenced treatment with rituximab and 90Y-ibritumomab tiuxetan. A second relapse occurred 22 months after radioimmunotherapy and was treated with a combination of fludarabine, cyclophosphamide, and mitoxantrone followed by rituximab. The patient experienced no further relapses until the current presentation (April, 2010).Pars plana vitrectomy with vitreous fluid analysis was performed in the right eye. PCR testing confirmed the presence of cytomegalovirus in the vitreous. Atypical lymphoid elements, highly suspicious of malignancy were also found on cytologic examination. Intravenous foscarnet was administered continually for three weeks, followed by oral valganciclovir given in a dose of 900 mg twice per day. In addition, the rituximab therapy continued at three monthly intervals. Nevertheless, cessation of foscarnet therapy was followed by a recurrence of retinitis on three separate occasions during a 3-month period instigating its reinduction to the treatment regime after each recurrence.ConclusionsCytomegalovirus retinitis is an opportunistic infection found in AIDS patients as well as in bone marrow and solid organ transplant recipients being treated with systemic immunosuppressive drugs. This case presents a less common incidence of cytomegalovirus retinitis occurring in a patient with non-Hodgkin’s lymphoma. We demonstrated a possible coexistence of cytomegalovirus retinitis and intraocular lymphoma in this particular patient. The final diagnosis was based on clinical manifestations together with the course of uveitis and its response to treatment alongside the results of vitreous fluid analysis. This report highlights the importance of intraocular fluid examination in cases with nonspecific clinical manifestations. Such an examination allows for the detection of simultaneously ongoing ocular diseases of differing aetiologies and enables the prompt initiation of effective treatment.

Atypical cytomegalovirus retinitis in non-Hodgkin's lymphoma

“…Svozílková et al 2 reported a case of bilateral CMV retinitis in an HIV-negative patient with NHL, with a normal lymphocyte count, who had white retinal lesions in both eyes. Vitreous fluid analysis showed atypical lymphoid elements, highly suspicious of malignancy, but PCR testing confirmed the presence of CMV in the vitreous.…”

Rétinite bilatérale à cytomégalovirus compliquant un lymphome folliculaire

“…La littérature reporte aussi un cas de rétinite à CMV chez une patiente atteinte d'un lymphone non hodgkinien, chez laquelle un traitement combiné (oral et intraveineux) a été suffisant pour arrêter l'atteinte oculaire [8].…”

A lymphoma patient with Cytomegalovirus retinitis and post‐autologous hematopoietic cell transplantation immune reconstitution uveitis: A case report and review of the literature

“…We identified 15 manuscripts with 24 cases of CMV retinitis in patients with lymphoma (Table ) . We excluded an additional three reports due to insufficient data …”

“…In nine of the 18 cases in which outcomes were described, the retinitis completely resolved. In four cases, CMV retinitis recurred after initial therapy . One episode was in the setting of initiating chemotherapy (unknown if the patient was still on antiviral therapy), two were after stopping anti‐CMV therapy, and one was during maintenance therapy with oral valganciclovir.…”

“…One episode was in the setting of initiating chemotherapy (unknown if the patient was still on antiviral therapy), two were after stopping anti‐CMV therapy, and one was during maintenance therapy with oral valganciclovir. The shortest interval to recurrence was 3 weeks after stopping anti‐CMV therapy . Two (8%) patients subsequently underwent autologous HCT without recurrence of retinitis .…”