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Bilateral Cytomegalovirus Retinitis in the Absence of Viremia

Shah, Christopher; Reddy, Ashvini
Shah, Christopher
Reddy, Ashvini
Purpose: To report a case of Polymerase Chain Reaction (PCR) Confirmed Bilateral Cytomegalovirus (CMV) retinitis in a patient with mantle cell lymphoma with no detectable CMV viremia. Methods: Case report. Patients/Results: A 67 year-old female with mantle cell lymphoma requiring multiple chemotherapeutic regimens and history of previously treated ganciclovir-resistant CMV colitis and viremia presented with bilateral necrotizing retinitis and panuveitis 3 months after her foscarnet was discontinued for undetectable viral loads. Her aqueous was positive for CMV by PCR; however, blood samples for CMV viral loads were negative on presentation as well as 3 months prior by serum PCR. She was treated with intravitreal and intravenous foscarnet and topical steroids with improvement initially, but ultimately developed a retinal detachment OD and severe macular edema with nonperfusion OS as well as bilateral uveitic glaucoma. Conclusion: CMV retinitis can occur in the absence of contemporaneous CMV viremia. This report demonstrates the utility of intraocular sampling for PCR in such cases and suggests that, especially in the chronically ill, physicians should maintain a high index of suspicion given the necessity for urgent intervention.
University of Virginia, 2015
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