Long-term prophylaxis in an immunocompetent patient with Cytomegalovirus retinitis: a case report and review of literature

Abstract

Background: Cytomegalovirus retinitis is an infectious sight-threatening condition that usually occurs in immunosuppressed individuals, but rare cases of Cytomegalovirus retinitis have been reported in immunocompetent patients. Findings: A 68-year-old woman without any history of systemic diseases referred to the emergency ward of Farabi eye hospital with a two-week history of decreased vision in her left eye. Fundoscopy of the left eye revealed mild venous tortuosity, hemorrhagic retinitis within the macula, and papillitis. The right eye had a history of Cytomegalovirus retinitis 2 years ago that complicated with rhegmatogenous retinal detachment. Immunologic evaluations were normal without any sign of immunosuppressive conditions. She was treated with intravenous ganciclovir for 2 weeks, intravitreal ganciclovir (twice weekly) for 1 week, and also daily oral valganciclovir as maintenance therapy for 6 months resulted in resolving of retinitis patches and improving her best-visual acuity from hand motions to 20/100. Forty-five days after stopping maintenance therapy recurrence occurred. So we started the treatment again to stabilize the patient. She is currently maintained on valganciclovir 900 mg daily without recurrence for 9 months. Conclusions: Cytomegalovirus retinitis can recur in the same or contralateral eye of immunocompetent patients, especially without prophylactic medication.

A Rare Case of Cytomegalovirus Retinitis in a Young Immunocompetent Patient

“…Patients with non-immunological conditions that cause limited immune dysfunction, such as diabetes, advanced age, hypertension, and intravitreal injections, can also acquire CMV retinitis if the virus is able to cross the blood-retinal barrier [ 4 , 5 ].…”