Regressing Phase of Cytomegalovirus Retinitis

A 28-year-old secretary initially presented with dysphagia and shortness of breath. She had low-grade fever but no night sweating and weight loss. Computed tomography (CT) scan demonstrated large lower neck and superior mediastinal tumour with nodal spread. The tumour compressed onto the trachea and oesophagus and encased the great vessels. Fine needle aspiration of the neck mass showed malignant cell infiltration. The patient underwent tracheal stenting and endotracheal biopsy, and a diagnosis of anaplastic large cell lymphoma was made.

Four cycles of CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) was given. However, chemotherapy was stopped due to severe bone marrow toxicity with neutropenic sepsis during each cycle despite growth factor support. CT scan after chemotherapy demonstrated a marked reduction in the size of the mediastinal mass and consolidation radiotherapy was given.

Towards the end of radiotherapy, the patient developed blurred vision associated with floaters in her left eye. Bilateral cytomegalovirus (CMV) retinitis was clinically diagnosed (Figure 1).¹ As the retinitis was assessed to be in a regressing phase, no systemic treatment was warranted.² She was therefore treated with topical dexamethasone/mepomycin/polymycin eyedrops with an improvement in symptoms.

Figure 1. Cytomegalovirus retinitis.

These days, CMV retinitis is seen most often in patients with AIDS. However, for patients with cancer receiving chemotherapy or undergoing transplant, less than 2% have severe opportunistic infections of the eye.³ Standard treatment is with systemic ganciclovir or foscarnet.⁴ Newer agents include valganciclovir and cidofovir. Possible complications of CMV retinitis are vitreal haemorrhage and retinal detachment.

References

1. Derzko-Dzulynsky LA, Berger AR, Berinstein NL. Cytomegalovirus retinitis and low-grade non-Hodgkin's lymphoma: case report and review of the literature. Am J Hematol 1998;57:228-232.
   
   
2. Kawai Y, Kawai R, Narayama T, et al. Successful treatment of cytomegalovirus retinitis in a patient with malignant lymphoma: a case report and review of the literature. Int J Hematol 1999; 69:256-259.
   
   
3. Guembel HO, Ohrloff C. Opportunistic infections of the eye in immunocompromised patients. Ophalmologica 1997;211 (Suppl 1):53-61.
   
   
4. Salmon-Ceron D. Cytomegalovirus infection: the pint in 2001. HIV Med 2001;2:255-259.
   

Dr Annette NY Poon
Medical Officer

Dr Wong Chun Sing
House Officer

Department of Clinical Oncology
Prince of Wales Hospital
Shatin, NT
Hong Kong.