An Interesting Case of CMV Retinitis in a Case of ALL on Maintenance Therapy

Singh, Pawan Kumar; Dayama, Aniruddha; Maiwall, Rakhi; Sehgal, Vineet; Venkatesh, Pradeep; Mishra, Pravas; Seth, Tulika; Mahapatra, Manoranjan

doi:10.1007/s12288-013-0305-9

Cited by 3 publications

(3 citation statements)

References 11 publications

(9 reference statements)

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“…[ 8 ] One previous report claimed that about 20% to 35% of allogeneic HSCT recipients may develop CMV infection if they do not receive any antiviral prophylaxis. [ 9 ] It is rather common that the retina is affected in acute leukemia, with about 70% of patients experiencing retinal symptoms, [ 10 ] but it is very rare for an ALL patient undergoing allogeneic HSCT to suffer CMV disease. Since there were clear signs of lesions in the retina in the fundoscopic and fluorescein angiographic evaluation, the pathology of this case of CMV retinitis seemed to involve vascular occlusion, hemorrhage, and exudates.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Zhao

Liu²,

Xu³

2017

Medicine

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Rationale:Cytomegalovirus (CMV) retinitis is a common opportunistic infection in immunocompromised patients, which may lead to blindness. CMV retinitis is not an uncommon infectious disease in patients with immune regulatory abnormalities, for example, human immunodeficiency virus (HIV) patients. However, CMV retinitis in a patient with acute lymphosarcoma leukemia (ALL) undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) phase is very rare.Patient concerns:A case of CMV retinitis in a patient receiving immunosuppressive therapy as a part of ALL allogeneic HSCT is described including the pathogenesis, clinical signs, and therapy.Diagnoses:CMV retinitis.Interventions:Ganciclovir intravitreal injection at weekly intervals for 4 weeks.Outcomes:Patient's vision had improved and the load of CMV deoxyribonucleic acid (DNA) in the aqueous humor declined. The CMV retinitis and perivascular of retina infiltration regressed.Lessons:We propose that the concentration of CMV DNA load in the aqueous humor could be useful in making the diagnosis and in selecting the optimal treatment in this kind of CMV retinitis.

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Section: Discussionmentioning

confidence: 99%

Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Zhao

Liu²,

Xu³

2017

Medicine

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“…Till date, there are only a few reports of CMVR in children with ALL on maintenance phase chemotherapy. [ 2 3 4 5 6 ] Maintenance therapy in ALL can cause severe immunosuppression leading to opportunistic infections including CMVR. Immunosuppression occurs due to low total leukocyte count, decreased total lymphocyte count, decreased CD4 count, reduced functional CD4 cells in the presence of normal absolute CD4 count,[ 1 ] and reduced immunoglobulin levels.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Recently, various case reports of CMV retinitis (CMVR) have been reported following intraocular or periocular corticosteroid administration and in children with leukemia, especially acute lymphoblastic leukemia (ALL). [ 2 3 4 5 6 ] Herein, we report a case of unilateral CMVR in a child during maintenance phase therapy for ALL who was not treated with autologous or allogeneic HSCT before.…”

Section: Introductionmentioning

confidence: 99%

Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir

et al. 2017

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Cytomegalovirus retinitis (CMVR) is an opportunistic infection seen in immunocompromised patients, especially suffering from acquired immune deficiency syndrome. It is uncommonly seen in hematological malignancies and in patients on immunosuppressants. The authors present a 12-year-old girl with unilateral CMVR who was on maintenance phase therapy for mixed phenotype (B/myeloid) leukemia. Serology for human immunodeficiency virus was negative. The child was successfully treated with oral valganciclovir and repeated intravitreal ganciclovir injections. CMVR in pediatric population with leukemia can be successfully treated with oral valganciclovir and intravitreal ganciclovir injections.

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Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

Shammary

Al-Mafrachi²,

Yousef³

et al. 2022

Open Access Maced J Med Sci

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BACKGROUND: Due to the reduced immune response following chemotherapy, cytomegalovirus (CMV) retinitis is the most prevalent opportunistic intraocular infection in HIV-infected adults. It can also affect children with acute lymphoblastic leukemia (ALL). CASE PRESENTATION: We describe an 11.5-year-old female who is undergoing maintenance chemotherapy for B-lineage ALL. She had vision loss in her right eye and began to have hazy vision in her left eye. Bilateral active retinitis lesions were discovered during the retinal examination. The diagnosis of bilateral CMVR was made based on clinical symptoms, retinal examination findings, and a blood sample for CMV DNA detection using the polymerase chain reaction (PCR) technique. She was given ganciclovir intravenously and intravitreally, followed by oral valganciclovir prophylaxis. Patients who received a solid organ or hematopoietic stem cell transplant were infected with CMVR, although patients with ALL who received less immunosuppressive chemotherapy were also affected (maintenance phase therapy). Intravenous and intravitreal ganciclovir injections are effective treatments, the patient had significant clinical improvement. CMV retinitis is frequent in children with ALL who are in the maintenance phase of the treatment. CONCLUSION: The importance of early detection and treatment cannot be overstated. CMV retinitis: Key prognostic variables. CMV retinitis should be considered as cause of blurred vision in patients with ALL.

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An Interesting Case of CMV Retinitis in a Case of ALL on Maintenance Therapy

Abstract: Forty-five years old male, a known case of T cell acute lymphoblastic leukemia (ALL) on maintenance therapy presented with bilateral painless progressive diminution of vision. Evaluation revealed cytomegalovirus (CMV) retinitis with low CD4

Cited by 3 publications

References 11 publications

Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation

Treatment of unilateral zone I cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir

Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

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