CMV retinitis in patients on mycophenolate immunosuppression: a report of two cases

Allergy, Asthma & Clinical Immunology

Case Report

Angeline L. Wang¹  Prem N. Patel¹  Ahmed M. Alkaliby²  Mitul C. Mehta² 

[1] Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, 75390-9057, Dallas, TX, USA;Gavin Herbert Eye Institute, UC Irvine, 92697, Irvine, CA, USA;

关键词: Cytomegalovirus;    Mycophenolate;    Retinitis;   

DOI  :  10.1186/s13223-023-00817-z

 received in 2022-09-01, accepted in 2023-06-15,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe rate of cytomegalovirus (CMV) retinitis is increasing, likely secondary to aggressive immunosuppressive regimens for a variety of diseases. Transplant and rheumatological literature show growing evidence suggesting a unique relationship between CMV infection and mycophenolate in particular. This study reports two cases of CMV retinitis infection in patients on mycophenolate immunosuppression.Case presentationCase A was a 39-year-old African American woman with systemic lupus erythematosus (SLE) with stage IV lupus nephritis who presented for bilateral retinal detachments with areas of moth-eaten and thin retina concerning for prior viral retinitis. Case B was a 53-year-old man who presented with floaters in the right eye status-post heart transplant since 2008 on immunosuppressive therapy. Fundoscopic examination of the right eye showed frosted branch angiitis with intraretinal hemorrhage and inner retinal thickening and disorganization, consistent with CMV retinitis infection. Both patients were on mycophenolate immunosuppression with the recommendation to reduce or discontinue mycophenolate.ConclusionPatients on mycophenolate immunosuppression may be more vulnerable to cytomegalovirus infection, including CMV retinitis. Ophthalmologists should be aware of this increased risk and consider reducing or discontinuing mycophenolate to promote viral clearance in these susceptible patients, in conjunction with the patient’s transplant or rheumatology teams.

【 授权许可】

CC BY   
© Canadian Society of Allergy & Clinical Immunology 2023

【 图 表 】

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Fig. 2