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Abstract
Purpose
To report a case of a patient with cytomegalovirus (CMV) retinitis who was treated with oral valganciclovir.
Case summary
A 34-year-old man who had undergone anticancer chemotherapy for Non-Hodgkin lymphoma was referred to the ophthalmologic oncology clinic because of decreased vision in both eyes. Fundus examination showed white, opaque, and granular retinal lesions in both eyes, and a serologic test showed a positive response to CMV antibody IgG and a negative response to CMV antibody IgM. The patient received induction therapy with intravenous ganciclovir and maintenance therapy with oral valganciclovir 900 mg once daily. CMV retinitis reactivated 4 weeks after maintenance therapy was discontinued. At that point, the patient received induction therapy with oral valganciclovir 900 mg twice daily for 3 weeks and maintenance therapy with 900 mg once daily for 5 weeks. The retinal lesion disappeared and did not recur after oral administration of valganciclovir. The patient discontinued valganciclovir after 5 weeks of maintenance therapy, and CMV retinitis did not reactivate during 6 months of follow-up.
References
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Figure 1.
Fundus photographs and fluorescein angiogram at the first visit. (A) Fundus photograph of the right eye shows white, opaque, irregular, and granular lesions superior to the fovea and superotemporal vascular arcade. (B) Fundus photograph of the left eye shows granular and small satellites appearance at the linear advanced border in the superotemporal portion. (C, D) Fluorescein angiogram of right eye at the early phase shows mild staining, and left eye shows linear retinal border of hypofluorescence. (E, F) Fluorescein angiogram of both eyes at the late phase show diffuse dye leakage from the previously hypo- or hyperfluorescence lesions.
Figure 2.
Fundus photographs after intravenous ganciclovir as induction therapy and oral valganciclovir as maintenance therapy.(A, B) After 2 weeks of intravenous ganciclovir as induction therapy, the granular lesions have decreased and the lesion border not advanced. (C, D) After 2 weeks of oral valganciclovir as maintenance therapy, the lesions have much decreased. Retinal vascular sheathing observed at the superotemporal portion of the left eye.
Figure 3.
Fundus photographs following reactivation of CMV retinitis. (A, B) CMV retinitis lesion following reactivation at 4 weeks after intravenous ganciclovir as induction therapy and oral valganciclovir as maintenance therapy were discontinued. The lesion border advanced more anteriorly and in circumferential directions than in the first attack. (C, D) After 2 weeks of oral valganciclovir as maintenance therapy, the granular lesions became less opacified. The area of infected retinal tissue has been replaced by a thin, gliotic scar, with the fine mottling of the retinal pigment epithelium.
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