2021, Number 2
<< Back Next >>
Rev Hematol Mex 2021; 22 (2)
Cytomegalovirus retinitis in a B-cell acute lymphoblastic leukemia patient
Rosales-Barajas T, Flores-Juárez MM, Dávila-Camargo A, Mondragón-González D, Valerio-Ramírez K, Reyes-Fernández H
Language: Spanish
References: 9
Page: 111-115
PDF size: 270.60 Kb.
ABSTRACT
Background: Cytomegalovirus retinitis is one the most common opportunistic
infection in immunosuppressed patients, patients with hematologic malignancy and
patients coursing with immunosuppressing therapy. It is the leading cause of bilateral
visual loss in AIDS patients. In patients with acute lymphoblastic leukemia, it can present
during the maintenance phase and it can be the first sign of central nervous system
affection or medullary relapse.
Clinical case: A 29-year-old female patient with cytomegalovirus retinitis and the
diagnosis of B-cell acute lymphoblastic leukemia. Patient first arrived to our service
with visual acuity of no light perception in both eyes, posterior segment examination
findings suggestive of cytomegalovirus retinitis, serological tests negative to HIV and
without evidence of medullary relapse or central nervous system affection. She was
treated with valganciclovir, showing clinical improvement of the retinal lesions but
with poor visual prognosis.
Conclusions: In immunosuppressed patients with suspicion of infectious retinitis,
empirical therapy should be started as soon as possible due to the relationship between
prognosis and the time elapsed since the beginning of the disease and the start of the
treatment, as well as the patient’s immunologic status.
REFERENCES
Rojas-Juárez S. Manual de retina médica y qurúrgica. 1a ed. Wolters Kluwer; 2017.
Sezgin E, An P, Winkler CA. Host genetics of cytomegalovirus (CMV) pathogenesis. Front Genet 2019; 10. doi. 10.3389/fgene.2019.00616.
Han SB, Lee JH, Lee JW, Chung NG, et al. Cytomegalovirus retinitis diagnosed after completion of chemotherapy for acute lymphoblastic leukemia in an adolescent. J Pediatr Hematol Oncol 2015; 37 (2): e128-30. doi. 10.1097/ MPH.0000000000000252.
Mateo J, Abarzuza R, Núñez E, Cristóbal JA. Bilateral optic nerve infiltration in acute lymphoblastic leukemia in remission. Arch Soc Esp Oftalmol 2007; 82 (3): 167-70. doi. 10.4321/s0365-66912007000300009.
Chawla R, Venkatesh P, Garg SP, Mandal S, et al. Cytomegalovirus retinitis in a patient with non-Hodgkin’s lymphoma: A diagnostic dilemma. Eur J Ophthalmol 2005; 15 (1): 153-7.
Ho M, Invernizzi A, Zagora S, Tsui J, et al. Presenting features, treatment and clinical outcomes of cytomegalovirus retinitis: Non-HIV patients vs HIV patients. Ocul Immunol Inflamm 2020; 28 (4): 651-8. https://doi.org/10.1080/09 273948.2019.1604003.
Orhan B, Malbora B, Bayar SA, Avcı Z, et al. Ophthalmologic findings in children with leukemia: A single-center study. Turk Ophthalmol 2016; 46 (2): 62-7. doi. 10.4274/tjo.03880.
Radwan A, Metzinger JL, Hinkle DM, Foster CS. Cytomegalovirus retinitis in immunocompetent patients: Case reports and literature review. Ocul Immunol Inflamm 2013; 21 (4): 324-8. doi. 10.3109/09273948.2013.786095.
Tripathy K, Mittal K, Venkatesh P, Bakhshi S, et al. Treatment of unilateral zone i cytomegalovirus retinitis in acute lymphoblastic leukemia with oral valganciclovir and intravitreal ganciclovir. Oman J Ophthalmol 2017; 10 (3): 250-2. doi. 10.4103/ojo.OJO_190_2016.
Full text