Cytomegalovirus retinitis with panretinal occlusive vasculopathy concealed by hypertensive uveitis: a case report
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Cytomegalovirus (CMV) retinitis is a rare disease, and overlapping manifestations involving the anterior segment are extremely uncommon. We report a patient who initially presented with persistent corneal edema and was later diagnosed with CMV retinitis. A 72-year-old man with uncontrolled intraocular pressure (IOP) in his right eye visited a tertiary hospital. At initial presentation, the IOP was 36 mmHg and the fundus was not clear due to corneal edema. Spectral domain optical coherence tomography revealed paracentral acute middle maculopathy (PAMM). Panretinal obstructive vasculopathy was observed on ultra-widefield fluorescein angiography. Three weeks later, trabeculectomy was performed to resolve the persistently high IOP. Once corneal edema improved, a white patch-like peripheral lesion and silver wire-like retinal vasculature were observed. Polymerase chain reaction of the aqueous humor was positive for CMV. Oral valganciclovir and intravitreal ganciclovir were administered as antiviral therapies. Despite treatment for 4 months, the final visual acuity was no light perception, with persistent corneal edema and neovascularization of the iris. We describe a rare case of the simultaneous occurrence of hypertensive uveitis and CMV retinitis. The presence of PAMM could be an initial identifiable sign of CMV retinitis, even in the presence of media opacity.
Abstract
Cytomegalovirus (CMV) retinitis is a rare disease, and overlapping manifestations involving the anterior segment are extremely uncommon. We report a patient who initially presented with persistent corneal edema and was later diagnosed with CMV retinitis. A 72-year-old man with uncontrolled intraocular pressure (IOP) in his right eye visited a tertiary hospital. At initial presentation, the IOP was 36 mmHg and the fundus was not clear due to corneal edema. Spectral domain optical coherence tomography revealed paracentral acute middle maculopathy (PAMM). Panretinal obstructive vasculopathy was observed on ultra-widefield fluorescein angiography. Three weeks later, trabeculectomy was performed to resolve the persistently high IOP. Once corneal edema improved, a white patch-like peripheral lesion and silver wire-like retinal vasculature were observed. Polymerase chain reaction of the aqueous humor was positive for CMV. Oral valganciclovir and intravitreal ganciclovir were administered as antiviral therapies. Despite treatment for 4 months, the final visual acuity was no light perception, with persistent corneal edema and neovascularization of the iris. We describe a rare case of the simultaneous occurrence of hypertensive uveitis and CMV retinitis. The presence of PAMM could be an initial identifiable sign of CMV retinitis, even in the presence of media opacity.
참고문헌 (20)
- Hirai K, "The mechanisms of human cytomegalovirus DNA replication", Nihon Rinsho, 56, pp.36~43 (1998)
- Port AD, "Cytomegalovirus retinitis : a review", J Ocul Pharmacol Ther, 33, pp.224~234 (2017)
- Standardization of Uveitis Nomenclature(SUN)Working Group, "Classification criteria for cytomegalovirus retinitis", Am J Ophthalmol, 228, pp.245~254 (2021)
- Kempen JH, "Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis", Ophthalmology, 113, pp.684~694 (2006)
- Ye Z, "Overview and update on cytomegalovirus-associated anterior uveitis and glaucoma", Front Public Health, 11, pp.1117412~ (2023)
- Wang I, "CMV retinitis with panretinal occlusive vasculitis", Ocul Immunol Inflamm, 32, pp.477~484 (2024)
- Schneider EW, "Chronic retinal necrosis : cytomegalovirus necrotizing retinitis associated with panretinal vasculopathy in non-HIV patients", Retina, 33, pp.1791~1799 (2013)
- Izzo MC, "Cytomegalovirus retinitis without immunocompromise", Retina Today, pp.53~55 (2021)
- Moorthy RS, "Glaucoma associated with uveitis", Surv Ophthalmol, 41, pp.361~394 (1997)
- Lewkowicz D, "Clinical outcome of hypertensive uveitis", J Ophthalmol, 2015, pp.974870~ (2015)
- Pohlmann D, "Virus-associated anterior uveitis and secondary glaucoma : diagnostics, clinical characteristics, and surgical options", PLoS One, 15, pp.e0229260~ (2020)
- Sobolewska B, "Long-term oral therapy with valganciclovir in patients with Posner-Schlossman syndrome", Graefes Arch Clin Exp Ophthalmol, 252, pp.117~124 (2014)
- Aumann S, "High resolution imaging in microscopy and ophthalmology: new frontiers in biomedical optics", pp.59~85 (2019), Springer International Publishing
- Sarraf D, "Paracentral acute middle maculopathy : a new variant of acute macular neuroretinopathy associated with retinal capillary ischemia", JAMA Ophthalmol, 131, pp.1275~1287 (2013)
- Liang S, "Association of paracentral acute middle maculopathy with visual prognosis in retinal artery occlusion : a retrospective cohort study", J Ophthalmol, 2022, pp.9404973~ (2022)
- Kam KW, "Iris depigmentation in the prediction of cytomegalovirus anterior uveitis", Ocul Immunol Inflamm, 30, pp.1775~1780 (2022)
- Long Z, "Neovascular complications from cytomegalovirus necrotizing retinopathy in patients after haploidentical hematopoietic stem cell transplantation", Retina, 41, pp.1526~1532 (2021)
- Park SH, "Rapidly progressive neovascular glaucoma associated with atypical cytomegalovirus retinitis : a case report", Korean J Ophthalmol, 36, pp.171~179 (2022)
- Tang Y, "The mechanism and therapeutic strategies for neovascular glaucoma secondary to diabetic retinopathy", Front Endocrinol(Lausanne), 14, pp.1102361~ (2023)
- Guzun OV, "Comprehensive treatment of patients with refractory glaucoma complicated by bullous keratopathy", J Ophthalmol(Ukraine), 1, pp.17~22 (2019)