CMV neuroretinitis in an immunocompetent patient: a unique case report

TL;DR

A rare case of CMV neuroretinitis is reported in an immunocompetent patient, highlighting the need for early diagnosis and treatment to prevent vision loss.

Contribution

This case report presents an unusual occurrence of CMV neuroretinitis in an immunocompetent individual.

Findings

The patient showed a positive response to valganciclovir treatment for CMV neuroretinitis.

The absence of typical risk factors made the diagnosis challenging and emphasized the need for high suspicion in atypical cases.

Early antiviral therapy helped prevent complications and preserve vision in this immunocompetent patient.

Abstract

Aim: To report a case of cytomegalovirus (CMV) neuroretinitis observed in an immunocompetent patient.

Materials and methods: The patient presented with a complaint of diminution of vision in both eyes (BE) and had a traumatic cataract in the right eye (RE). Fundus examination of the left eye (LE) revealed an active white, fluffy lesion with an overlying retinal hemorrhage patch with a macular star. The diagnosis of CMV neuroretinitis was established, and the patient commenced treatment with valganciclovir.

Results: The patient exhibited no underlying risk factors. Subsequently, a positive response to oral valganciclovir treatment was observed.

Discussion: Cytomegalovirus (CMV) neuroretinitis is typically associated with immunocompromised individuals, such as those with HIV/AIDS. The patient’s presentation with a traumatic cataract in the right eye and a distinctive fundus appearance in the left eye posed a diagnostic challenge. The absence of common risk factors for CMV infection necessitated a thorough examination and consideration of rare infectious etiologies. The positive response to valganciclovir reinforces its efficacy in managing CMV-related ocular conditions. This case emphasized the necessity for ophthalmologists to maintain a high index of suspicion for CMV and other unusual pathogens when faced with neuroretinitis in patients who do not present with typical systemic immunosuppressive conditions. Early diagnosis and appropriate antiviral therapy prevent potential complications and preserve vision in such atypical presentations.

Conclusion: This case underscores the importance of considering rare infectious agents in immunocompetent patients when encountering neuroretinitis, particularly in the absence of typical symptoms or signs of the disease.

Abbreviations: CMV = Cytomegalovirus, BE = Both eyes, RE = Right eye, LE = Left eye, CBC = Complete Blood Count, ESR = Erythrocyte Sedimentation Rate, VDRL = Venereal Disease Research Laboratory, FTA-ABS = Fluorescent Treponemal Antibody Absorption, PPD = Purified Protein Derivative, ANA = Anti-Nuclear Antibodies, RF = Rheumatoid Factor, ACE = Anti Converting Enzyme, Ig G = Immunoglobulin G, HSV = Herpes simplex virus

Figures