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Bilateral toxoplasma retinochoroiditis simulating cytomegalovirus retinitis in an allogeneic bone marrow transplant patient.

Chung H, Kim JG, Choi SH, Lee SY, Yoon YH - Korean J Ophthalmol (2008)

Bottom Line: She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition.After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved.Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

ABSTRACT
A 36-year old female with acute myelogenous leukemia presented with a sudden decrease in vision one month following bone marrow transplantation (BMT). She had been taking multiple immunosuppressants to treat her recently-developed graft-versus-host-disease (GVHD). Visual acuity was 20/60 in her right eye and 20/25 in her left. Ophthalmic examination revealed mild inflammatory reaction in both the anterior chamber and the vitreous of both eyes, as well as densely opaque yellow-white infiltrates with well-demarcated borders in the posterior retina of both eyes. She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition. Subsequent work-up, including serology and brain MRI, led to a diagnosis of combined ocular and cerebral toxoplasmosis. After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved. Immunosuppressed patients with necrotizing retinochoroiditis should be suspected of having toxoplasmosis. Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

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Related in: MedlinePlus

Fundus photographs and optical coherence tomography (OCT) at presentation in the patient's right (a, b) and left (c, d) eyes. Her visual acuity was 20/60 in the right eye and 20/25 in the left eye.
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Figure 1: Fundus photographs and optical coherence tomography (OCT) at presentation in the patient's right (a, b) and left (c, d) eyes. Her visual acuity was 20/60 in the right eye and 20/25 in the left eye.

Mentions: Ophthalmic examination revealed visual acuity of 20/60 in the right eye and 20/25 in the left. There were mild cellular reactions in the anterior chambers and vitreous humors of both eyes. Densely opaque, yellow-white curvilinear infiltrates of 2 disc area size were observed with a small satellite lesion at the posterior retina of her right fundus. A similar infiltrate was also identified temporal to the macula in her left eye (Fig. 1). No retinal hemorrhage was found. Blood test showed positive CMV antigenemia (12/200,000 WBC). Necrotizing retinitis in the posterior pole with CMV antigenemia in this immunocompromised patient prompted us to make diagnosis of CMV retinitis. However, despite 2 weeks treatment with intravenous ganciclovir (2.5 mg/kg daily, dose adjusted to her glomerular filtration rate), her retinal lesion worsened and new satellites appeared (Fig. 2). In addition her vision had decreased to 20/400 in the right eye, and 20/60 in the left.


Bilateral toxoplasma retinochoroiditis simulating cytomegalovirus retinitis in an allogeneic bone marrow transplant patient.

Chung H, Kim JG, Choi SH, Lee SY, Yoon YH - Korean J Ophthalmol (2008)

Fundus photographs and optical coherence tomography (OCT) at presentation in the patient's right (a, b) and left (c, d) eyes. Her visual acuity was 20/60 in the right eye and 20/25 in the left eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629896&req=5

Figure 1: Fundus photographs and optical coherence tomography (OCT) at presentation in the patient's right (a, b) and left (c, d) eyes. Her visual acuity was 20/60 in the right eye and 20/25 in the left eye.
Mentions: Ophthalmic examination revealed visual acuity of 20/60 in the right eye and 20/25 in the left. There were mild cellular reactions in the anterior chambers and vitreous humors of both eyes. Densely opaque, yellow-white curvilinear infiltrates of 2 disc area size were observed with a small satellite lesion at the posterior retina of her right fundus. A similar infiltrate was also identified temporal to the macula in her left eye (Fig. 1). No retinal hemorrhage was found. Blood test showed positive CMV antigenemia (12/200,000 WBC). Necrotizing retinitis in the posterior pole with CMV antigenemia in this immunocompromised patient prompted us to make diagnosis of CMV retinitis. However, despite 2 weeks treatment with intravenous ganciclovir (2.5 mg/kg daily, dose adjusted to her glomerular filtration rate), her retinal lesion worsened and new satellites appeared (Fig. 2). In addition her vision had decreased to 20/400 in the right eye, and 20/60 in the left.

Bottom Line: She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition.After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved.Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.

ABSTRACT
A 36-year old female with acute myelogenous leukemia presented with a sudden decrease in vision one month following bone marrow transplantation (BMT). She had been taking multiple immunosuppressants to treat her recently-developed graft-versus-host-disease (GVHD). Visual acuity was 20/60 in her right eye and 20/25 in her left. Ophthalmic examination revealed mild inflammatory reaction in both the anterior chamber and the vitreous of both eyes, as well as densely opaque yellow-white infiltrates with well-demarcated borders in the posterior retina of both eyes. She was originally diagnosed as CMV retinitis, but treatment with ganciclovir failed to improve her ocular condition. Subsequent work-up, including serology and brain MRI, led to a diagnosis of combined ocular and cerebral toxoplasmosis. After 6 weeks of antiparasitic therapy, her retinal lesions became inactive and her cerebral lesions improved. Immunosuppressed patients with necrotizing retinochoroiditis should be suspected of having toxoplasmosis. Accurate differentiation between this condition and CMV, and early intervention with the appropriate treatment may be critical to preserve the best vision.

Show MeSH
Related in: MedlinePlus