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21-03-2013 | Infectious disease | Article

CMV posterior eye infection can occur without immune compromise


Free abstract

medwireNews: Cytomegalovirus (CMV)-associated posterior uveitis or panuveitis may occur in patients without evidence of immune insufficiency and is characterized by vitreous inflammation, researchers report.

CMV is a common cause of posterior eye segment infection in patients with human immunodeficiency virus (HIV) infection but is less well studied in patients without the disease.

To investigate, Kessara Pathanapitoon (Chiang Mai University, Thailand) and colleagues retrospectively reviewed medical records of 18 patients (22 affected eyes) who tested positive for CMV in the intraocular fluid.

The mean age of patients was 49 years, 11 were male, and the diagnosis was posterior uveitis in six patients and panuveitis in 12. Ocular features included focal hemorrhagic retinitis in 13 patients and peripheral retinal necrosis in seven; notably, all patients displayed vitreous inflammation.

With regard to comorbidities, 11 of 18 patients were taking immunosuppressive medications for indications including organ transplantation, autoimmune connective tissue disease, and hematologic malignancy, while two further patients had autoimmune disorders.

Of the remaining five patients, two had diabetes mellitus with nonproliferative diabetic retinopathy while the other three had no systemic diseases and were not taking immunosuppressive drugs either at diagnosis of CMV eye infection or during a mean follow-up period of 24 months.

The clinical manifestations did not differ among the various subgroups of patients. However, all five patients without evidence of immunosuppression showed unilateral involvement, of whom one had a focal retinal lesion, two had peripheral retinal necrosis, and two exhibited only vitritis and vasculitis without other retinal lesions.

Also, all five manifested severe vitritis, all had retinal arteritis, and four had anterior chamber inflammatory reactions.

With regard to treatment, systemic or intraocular ganciclovir helped reduce signs of inflammation and the lesions became inactive within 6-8 weeks. Immunosuppressive medications were decreased or withdrawn in four patients, none of whom exhibited features consistent with immune reconstitution uveitis.

Writing in JAMA Ophthalmology, Pathanapitoon et al conclude: "Clinical features of CMV-associated posterior segment eye infection in patients without HIV infection might differ from those of patients with HIV infection and typically include signs of intraocular inflammation and the presence of vasculitis, with the frequent involvement of arteries.

"It may be that CMV infection located in posterior eye segments of patients without HIV infection is more frequent and has more variable clinical presentation than previously thought."

By Joanna Lyford, Senior medwireNews Reporter