Subacute Vision Loss in a Patient With Limited Immune Dysfunction

Abstract

A 62-year-old man presented with subacute, painless vision loss in the right eye that developed over the course of 1 week. He had a history of well-controlled type 2 diabetes and diffuse large B-cell lymphoma that was diagnosed 3 years earlier. The lymphoma was initially treated with chemotherapy, followed by a relapse that required additional chemotherapy and ultimately autologous bone marrow transplant 3 months before presentation. At the time of presentation, he was taking no immunosuppressive medications and was taking prophylactic acyclovir, 800 mg twice daily, and sulfamethoxazole/ trimethoprim (800 mg/1600 mg) 3 times weekly.Snellen visual acuity measured 20/40 OD and 20/20 OS. Intraocular pressure (IOP) measured 24 mm Hg OD and 12 mm Hg OS. There was no afferent pupillary defect. Right eye examination results revealed 1+ anterior chamber inflammation, iris neovascularization, keratic precipitates, vitritis, and a granular necrotizing retinitis (Figure , A). Left eye examination results were unremarkable. Fluorescein angiography of the right eye demonstrated panretinal occlusive vasculopathy with severe peripheral nonperfusion (Figure , B). His white blood cell count was moderately low at 3.1 kilos/μL (to convert to ×10 9 /L, multiply by 0.001; reference range, 4.0-10.0 kilos/μL); a complete blood count and serum chemistry panel were otherwise normal. Human immunodeficiency virus (HIV) testing results were negative. An aqueous tap was performed and sent for culture and polymerase chain reaction. A Wide-field fundus photograph B Late-phase fluorescein angiogram Clinical Review & Education

A case of chronic retinal necrosis after tube shunt surgery for secondary glaucoma associated with cytomegalovirus corneal endotheliitis

“…CRN combined with CMV endotheliitis has not been reported previously. To the best of our knowledge, three reports of seven CRN cases have been published [ 1 , 5 , 6 ]. In the initial report of five CRN cases [ 1 ], a retinal detachment developed in one case and neovascular complications developed in four cases during the follow-up.…”