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Meller L, Jagadeesh V, Wilson K, Oca MC, Sestak T, Scott N. Bilateral Cytomegalovirus Retinitis After Chimeric Antigen Receptor T-cell Therapy for B-cell Lymphoma. Cureus 2024; 16:e56637. [PMID: 38646322 PMCID: PMC11032111 DOI: 10.7759/cureus.56637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Cytomegalovirus (CMV) retinitis is commonly associated with immunosuppression and can cause irreversible vision loss. Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as an effective cancer treatment option but requires immunosuppression, thereby increasing the possibility of acquiring opportunistic infections such as CMV. We present the case of a 76-year-old female with a history of hypertension and type 2 diabetes mellitus who initially presented with shortness of breath and was diagnosed with the activated B-cell subset of diffuse large B-cell lymphoma (DLBCL). She received multiple cycles of chemotherapy and experienced relapses with cardiac involvement. The patient developed vision loss in the right eye and was diagnosed with bilateral posterior vitritis. She underwent various treatments, including radiotherapy, systemic chemotherapy, cataract extraction, and vitrectomy. After CAR-T therapy, she developed bilateral CMV retinitis, confirmed through polymerase chain reaction testing and managed by valganciclovir. Overall, this case report describes the first reported case of bilateral CMV retinitis following CAR-T therapy for DLBCL. It emphasizes the need for early recognition and treatment of CMV retinitis to prevent permanent vision loss. The report also underscores the importance of regular ocular screening and consideration of prophylactic measures in patients undergoing CAR-T therapy.
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Affiliation(s)
- Leo Meller
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
| | - Vasan Jagadeesh
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
| | - Katherine Wilson
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
| | - Michael C Oca
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
| | - Timothy Sestak
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
| | - Nathan Scott
- Viterbi Family Department of Ophthalmology at the Shiley Eye Institute, University of California San Diego School of Medicine, La Jolla, USA
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Bin dokhi H, Alharbi AO, Ibnouf NH, Alahmari B, Refka MN. Post-CD19 Chimeric Antigen Receptor T-Cell Therapy Cytomegalovirus Retinitis. Cureus 2022; 14:e23002. [PMID: 35415043 PMCID: PMC8993130 DOI: 10.7759/cureus.23002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this case report was to present a case of cytomegalovirus (CMV) retinitis in a patient with diffuse large B-cell lymphoma (DLBCL) post-CD19 chimeric antigen receptor (CAR) T-cell therapy. A 43-year-old female patient who was complaining of metamorphopsia and sudden blurring in the vision of her left eye was referred to the ophthalmology department. The patient had DLBCL and was started on systemic chemotherapy, which showed no response to therapy and disease progression. Therefore, she was diagnosed with primary refractory DLBCL and treated with CAR T-cell therapy. The visual acuity of the left eye was 20/25 in the left eye on the Snellen visual acuity chart. The dilated fundus examination of the left eye demonstrated a diffuse yellowish retinal infiltration radiating from the optic disc involving the inferior macula and inferotemporal arcade. A color fundus image of the left eye showed a creamy infiltrate involving the inferior half of the macula sparing the fovea with subtle small white lesions in the midperiphery. Horizontal cross-section optical coherence tomography (OCT) of the macula of the left eye showed islands of destruction of all the retinal layers, which are replaced with moderately hyperreflective material; these infiltrates spare the fovea but with subfoveal fluid. Further systemic evaluation indicated CMV viremia reactivation and an absolute CD4+ cells count of 13 cells/mcL. Thus, she was diagnosed with CMV retinitis. After three days of the initial presentation, she received the first intravitreal ganciclovir injection; 17 days after presentation, she received five intravitreal ganciclovir injections. The patient responded well to intravitreal ganciclovir therapy. She regained very good vision, and the visual acuity was 20/20 in both eyes. Early recognition and initiation of proper treatment are crucial. Thus, any visual complaints in patients with immunodeficiency should be taken seriously and should be further assessed. As the right eye had retinal scaring indicating previous retinitis, prophylactic treatment with ganciclovir could have been used to reduce the risk of retinitis development in the left eye.
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Munshi A, Almarhabi H, Mujalled MK, Alturkistani F, Althaqafi A. Simultaneous Occurrence of Cytomegalovirus Colitis and Retinitis as the Initial Presentation of Human Immunodeficiency Virus Infection in a Patient With Zero CD4 Count. Cureus 2022; 14:e22455. [PMID: 35345706 PMCID: PMC8942289 DOI: 10.7759/cureus.22455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/05/2022] Open
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Generalized Pruritus and Gradual Loss of Vision as the Presenting Complaints of Acute HIV Infection: Management Challenges during COVID-19 Pandemic. Case Rep Infect Dis 2021; 2021:6436936. [PMID: 34868691 PMCID: PMC8633852 DOI: 10.1155/2021/6436936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background Although the prevalence of HIV is low in Bangladesh, there is a potential for an increased number of cases. This is because of high cross-border mobility (India and Myanmar) of people and increased injection drug abusers amongst youth in the cities and rural areas, HIV can present in many ways, from asymptomatic to advanced disease, including various atypical (generalized itching) and advanced (loss of vision) manifestations. A high degree of suspicion is required to diagnose HIV in a country like Bangladesh. Early diagnosis and prompt treatment are essential to have a better outcome. Methods Here, we report two thought-provoking cases where patients were suffering from generalized itchy lesions (pruritic papular eruption) throughout the body for a long time and gradual loss of vision in another case. Results Due to lack of suspicion, initially, HIV screening was not done. Both patients visited several health centres, but no diagnosis was made. Moreover, COVID-19 pandemic worsens the situation. Finally, they were diagnosed with HIV; unfortunately, one of them lost her vision due to CMV retinitis and another patient died of other complications. Conclusion Ongoing COVID-19 pandemic put many challenges to ensure optimum care, especially for patients with long-sufferings like HIV. Clinicians have to have a very high degree of suspicion while dealing with patients presented with rare manifestations, particularly in a low endemic clinical setting.
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A Mouse Model That Mimics AIDS-Related Cytomegalovirus Retinitis: Insights into Pathogenesis. Pathogens 2021; 10:pathogens10070850. [PMID: 34358000 PMCID: PMC8308774 DOI: 10.3390/pathogens10070850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022] Open
Abstract
With the appearance of the worldwide AIDS pandemic four decades ago came a number of debilitating opportunistic infections in patients immunosuppressed by the pathogenic human retrovirus HIV. Among these was a severe sight-threatening retinal disease caused by human cytomegalovirus (HCMV) that remains today a significant cause of vision loss and blindness in untreated AIDS patients without access or sufficient response to combination antiretroviral therapy. Early investigations of AIDS-related HCMV retinitis quickly characterized its hallmark clinical features and unique histopathologic presentation but did not begin to identify the precise virologic and immunologic events that allow the onset and development of this retinal disease during HIV-induced immunosuppression. Toward this end, several mouse models of experimental cytomegalovirus retinitis have been developed to provide new insights into the pathophysiology of HCMV retinitis during AIDS. Herein, we provide a summary and comparison of these mouse models of AIDS-related HCMV retinitis with particular emphasis on one mouse model developed in our laboratory in which mice with a murine acquired immunodeficiency syndrome (MAIDS) of murine retrovirus origin develops a reproducible and well characterized retinitis following intraocular infection with murine cytomegalovirus (MCMV). The MAIDS model of MCMV retinitis has advanced the discovery of many clinically relevant virologic and immunologic mechanisms of virus-induced retinal tissue destruction that are discussed and summarized in this review. These findings may extend to the pathogenesis of AIDS-related HCMV retinitis and other AIDS-related opportunistic virus infections.
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Kobayashi T, Sato JI, Ikuta K, Kanno R, Nishiyama K, Koshizuka T, Ishioka K, Suzutani T. Modification of the HCMV-specific IFN-γ release test (QuantiFERON-CMV) and a novel proposal for its application. Fukushima J Med Sci 2017. [PMID: 28638004 DOI: 10.5387/fms.2017-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Human cytomegalovirus (HCMV) is universally distributed among humans without any adverse effects; however, it induces severe diseases in immunocompromised patients such as organ transplant recipients and AIDS patients. To manage these immunocompromised patients, an easy clinical examination for the monitoring of disease risk is required. In this study, we modified the interferon-γ (IFN-γ) release test (QuantiFERON®-CMV) using HCMV immediate early-1 (IE-1) or pp65 whole proteins, or UV-inactivated HCMV particles as an antigen. The response of heparinized peripheral blood from healthy volunteers to the pp65 protein showed an obvious dose-dependent sigmoid curve, although no correlation was observed between results of this assay and an ELISPOT assay. The addition of pp65 to the blood samples at a final concentration of 1×103 to 1×105 pg/ml was found to be optimum. Using this assay, we observed a significant enhancement in cellular immunity in volunteers after the daily ingestion of yogurt for 8 weeks, which suggested a novel application of the assay in addition to monitoring HCMV infection risk. IFN-γ secretion from peripheral blood cells on HCMV-antigen stimulation differed significantly between individuals; therefore, the assay could not be normalized. Nevertheless, it was found to be particularly useful for observing fluctuations in cellular immune activity on an individual level.
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Affiliation(s)
- Takahiro Kobayashi
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Jun-Ichi Sato
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Kazufumi Ikuta
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima.,Division of Microbiology, Tohoku Medical and Pharmaceutical University
| | - Ryoko Kanno
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Kyoko Nishiyama
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Tetsuo Koshizuka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Ken Ishioka
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University School of Medicine, Fukushima
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Zhao N, Liu L, Xu J. Cytomegalovirus retinitis in a patient with secondary acute lymphosarcoma leukemia undergoing allogeneic hematopoietic stem-cell transplantation: A rare case report: a care-compliant article. Medicine (Baltimore) 2017; 96:e6878. [PMID: 28489788 PMCID: PMC5428622 DOI: 10.1097/md.0000000000006878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Cytomegalovirus (CMV) retinitis is a common opportunistic infection in immunocompromised patients, which may lead to blindness. CMV retinitis is not an uncommon infectious disease in patients with immune regulatory abnormalities, for example, human immunodeficiency virus (HIV) patients. However, CMV retinitis in a patient with acute lymphosarcoma leukemia (ALL) undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) phase is very rare. PATIENT CONCERNS A case of CMV retinitis in a patient receiving immunosuppressive therapy as a part of ALL allogeneic HSCT is described including the pathogenesis, clinical signs, and therapy. DIAGNOSES CMV retinitis. INTERVENTIONS Ganciclovir intravitreal injection at weekly intervals for 4 weeks. OUTCOMES Patient's vision had improved and the load of CMV deoxyribonucleic acid (DNA) in the aqueous humor declined. The CMV retinitis and perivascular of retina infiltration regressed. LESSONS We propose that the concentration of CMV DNA load in the aqueous humor could be useful in making the diagnosis and in selecting the optimal treatment in this kind of CMV retinitis.
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Affiliation(s)
| | | | - Junjie Xu
- Department of Laboratory Medicine, Key Laboratory of AIDS Immunology of National Health and Family Planning Commission, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
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Retinal Microvasculopathy Is Common in HIV/AIDS Patients: A Cross-Sectional Study at the Cape Coast Teaching Hospital, Ghana. J Ophthalmol 2016; 2016:8614095. [PMID: 28127467 PMCID: PMC5227161 DOI: 10.1155/2016/8614095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/06/2016] [Indexed: 11/26/2022] Open
Abstract
Purpose. The purpose of this study was to evaluate the ocular disorders in HIV positive patients attending the Cape Coast Teaching Hospital, Ghana. Methods. A cross-sectional study using systematic random sampling was conducted on 295 HIV positive patients. Data collection consisted of semistructured questionnaires, laboratory investigation, medical profile, and ophthalmic examination. Statistical association tests including χ2, independent t-test, and ANOVA were done. A p value ≤ 0.05 was considered statistically significant. Results. Of the 295 participants, 205 (69.5%) were on antiretroviral therapy while 90 (30.3%) were not on therapy. Majority of the participants (162, 54.9%) were in clinical stage two, followed by stages three (68, 23.1%), one (62, 21%), and four (3, 1%), respectively. The overall prevalence of ocular disorders was 5.8%. The most common HIV related ocular disorder was HIV retinal microvasculopathy (58.8%), followed by herpes zoster ophthalmicus and Toxoplasma retinochoroiditis, both representing 11.8% of ocular disorders seen. Cytomegalovirus retinitis, Bell's palsy, and optic neuritis were the least common (5.9%). CMV retinitis recorded the highest viral load of 1,474,676 copies/mL and mean CD4 count of 136 cells/mm3. The mean CD4 count for participants with HIV related ocular disorders was significantly lower compared to participants without disorders (t = 2.5, p = 0.012). Participants with ocular disorders also recorded significantly higher mean viral loads than those who did not have ocular disorders (t = 2.8, p = 0.006). Conclusion. Lower CD4 counts and high viral load copies were associated with the manifestation of HIV related ocular disorders.
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Boiko EV, Pozniak AL, Maltsev DS, Suetov AA, Nuralova IV. High frequency of latent Chlamydia trachomatis infection in patients with rhegmatogenous retinal detachment. Int J Ophthalmol 2016; 9:863-8. [PMID: 27366689 DOI: 10.18240/ijo.2016.06.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the frequency of detection of ocular and extraocular Chlamydia trachomatis (CT) infection in non-high myopes with rhegmatogenous retinal detachment (RRD). METHODS This was a single-center, nonrandomized, prospective, case-control study. One hundred and four patients were divided into a study group with RRD (n=63) and a control group with traumatic retinal detachment (n=41). Samples of subretinal fluid (SFR), conjunctival, urethral/cervical swabs, and blood were collected. The frequency of detection of CT infection in SRF samples was determined by polymerase chain reaction (PCR), direct fluorescence assay (DFA) and cell culture, whereas that in conjunctival swabs was determined by PCR and DFA, and those in urethral/cervical swabs and blood were determined by DFA. Yates Chi-square test (with Bonferroni correction) and two-tailed Student's t-test were used for statistical analysis. RESULTS SRF CT infection was detected more frequently in the study group (50.8%-71.4%) than in the control group (9.8%-12.2%) by all the methods used (P<0.01). The frequency of detection of conjunctival CT infection by DFA was higher in the RRD patients compared with the controls (81.0% vs 24.4%, P=0.004). The PCR detected conjunctival CT infection more often in the study group than in the controls (46.0% vs 9.8%, P=0.007). The DFA detected CT in blood specimens almost as frequently as in urogenital specimens, for the RRD patients (61.2% vs 63.5%) and the controls (7.3% vs 9.8%). CONCLUSION CT infection is detected with high frequency in non-high myopes with RRD.
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Affiliation(s)
- Ernest V Boiko
- St. Petersburg Branch of the Academician S. Fyodorov IRTC "Eye Microsurgery", St. Petersburg 192283, Russia; Department of Ophthalmology, Military Medical Academy, St. Petersburg 194044, Russia
| | - Alexei L Pozniak
- St. Petersburg Branch of the Academician S. Fyodorov IRTC "Eye Microsurgery", St. Petersburg 192283, Russia
| | - Dmitrii S Maltsev
- St. Petersburg Branch of the Academician S. Fyodorov IRTC "Eye Microsurgery", St. Petersburg 192283, Russia
| | - Alexei A Suetov
- St. Petersburg Branch of the Academician S. Fyodorov IRTC "Eye Microsurgery", St. Petersburg 192283, Russia
| | - Irina V Nuralova
- St. Petersburg Branch of the Academician S. Fyodorov IRTC "Eye Microsurgery", St. Petersburg 192283, Russia
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Ruiz-Cruz M, Alvarado-de la Barrera C, Ablanedo-Terrazas Y, Reyes-Terán G. Proposed clinical case definition for cytomegalovirus-immune recovery retinitis. Clin Infect Dis 2014; 59:298-303. [PMID: 24771331 DOI: 10.1093/cid/ciu291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) retinitis has been extensively described in patients with advanced or late human immunodeficiency virus (HIV) disease under ineffective treatment of opportunistic infection and antiretroviral therapy (ART) failure. However, there is limited information about patients who develop active cytomegalovirus retinitis as an immune reconstitution inflammatory syndrome (IRIS) after successful initiation of ART. Therefore, a case definition of cytomegalovirus-immune recovery retinitis (CMV-IRR) is proposed here. METHODS We reviewed medical records of 116 HIV-infected patients with CMV retinitis attending our institution during January 2003-June 2012. We retrospectively studied HIV-infected patients who had CMV retinitis on ART initiation or during the subsequent 6 months. Clinical and immunological characteristics of patients with active CMV retinitis were described. RESULTS Of the 75 patients under successful ART included in the study, 20 had improvement of CMV retinitis. The remaining 55 patients experienced CMV-IRR; 35 of those developed CMV-IRR after ART initiation (unmasking CMV-IRR) and 20 experienced paradoxical clinical worsening of retinitis (paradoxical CMV-IRR). Nineteen patients with CMV-IRR had a CD4 count of ≥50 cells/µL. Six patients with CMV-IRR subsequently developed immune recovery uveitis. CONCLUSIONS There is no case definition for CMV-IRR, although this condition is likely to occur after successful initiation of ART, even in patients with high CD4 T-cell counts. By consequence, we propose the case definitions for paradoxical and unmasking CMV-IRR. We recommend close follow-up of HIV-infected patients following ART initiation.
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Affiliation(s)
- Matilde Ruiz-Cruz
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Claudia Alvarado-de la Barrera
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Yuria Ablanedo-Terrazas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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Colby DJ, Vo DQ, Teoh SC, Tam NT, Liem NT, Lu D, Nguyen TT, Cosimi L, Pollack T, Libman H. Prevalence and predictors of cytomegalovirus retinitis in HIV-infected patients with low CD4 lymphocyte counts in Vietnam. Int J STD AIDS 2013; 25:516-22. [PMID: 24327723 DOI: 10.1177/0956462413515197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022]
Abstract
We describe the results of a study to determine the prevalence and characteristics of cytomegalovirus (CMV) retinitis among HIV-infected patients in Vietnam. We conducted a cross-sectional prospective study of patients with CD4 lymphocyte count ≤100 cells/mm(3)recruited from public HIV clinics. The diagnosis was made by a trained ophthalmologist using slit lamp biomicroscopy and corroborated on fundus photography. A total of 201 patients were screened. The median age was 32 years, 77% were men, median CD4 count was 47 cells/mm(3), and 62% were on antiretroviral treatment. Prevalence of CMV retinitis was 7% (14/201, 95% CI 4-11%). CMV retinitis was not associated with age, gender, injection drug use, CD4 count, WHO clinical stage, or antiretroviral treatment status. Blurring of vision and reduced visual acuity <20/40 were associated with CMV retinitis, but only 29% of patients with the diagnosis reported blurry vision and only 64% had abnormal vision. On multivariate analysis, the sole predictor for CMV retinitis was decreased visual acuity (OR 22.8,p < 0.001). In Ho Chi Minh City, CMV retinitis was found in 7% of HIV-infected patients with low CD4. HIV-infected patients with a CD4 count <100/mm(3)or who develop blurring of vision in Vietnam should be screened for CMV retinitis.
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Affiliation(s)
- Donn J Colby
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Diem Qh Vo
- Retina Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
| | - Stephen C Teoh
- National Healthcare Group Eye Institute, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Nguyen T Tam
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Nguyen T Liem
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Doanh Lu
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thi T Nguyen
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam
| | - Lisa Cosimi
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
| | - Todd Pollack
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Howard Libman
- Harvard Medical School AIDS Initiative in Vietnam, Ho Chi Minh City, Vietnam Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Miao H, Tao Y, Jiang YR, Li XX. Multiple intravitreal injections of ganciclovir for cytomegalovirus retinitis after stem-cell transplantation. Graefes Arch Clin Exp Ophthalmol 2013; 251:1829-33. [PMID: 23665863 DOI: 10.1007/s00417-013-2368-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/17/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in patients after hematopoietic stem cell transplantation (HSCT). Although much effort has been put into dealing with CMV retinitis secondary to acquired immunodeficiency syndrome (AIDS), the few reports which have been published have mainly focused on treatment of CMVR after HSCT. METHODS This clinical interventional retrospective study included 14 patients (eight men; mean age 23.89 ± 12.09; 23 eyes) who suffered from CMV retinitis after stem-cell transplantation, in order to evaluate the efficacy and safety of multiple intravitreal injections of ganciclovir (IVG) for patients with CMV retinitis. All patients received 4 injections of IVG of 1 mg at 1 week intervals, and were followed up weekly for at least 2 months with measurement of best-corrected visual acuity (BCVA) and CMV levels in anterior aqueous humor with real-time polymerase chain reaction. Anterior aqueous humor was obtained before each injection. RESULTS The levels of CMV in anterior aqueous humor showed significant decrease from (6.34 ± 15.78) × 10(5) copies/ml at baseline to (5.22 ± 12.15) × 10(3) copies/ml at 1 month (P < 0.001, Mann-Whitney U test). CMV couldn't be detected in 11 eyes (47.8 %) after two injections, and this rose to 18 eyes (78.3 %) at 1 month. The mean logMAR BCVA was 0.659 ± 0.572 at baseline and 0.680 ± 0.527 at 2 months, which suggested no significant improvement (P = 0.736, Mann-Whitney U test) during the procedure. All patients experienced improved vitreous opacity and diminished area of the lesion under funduscopy after 4 injections of IVG. No severe complications developed. CONCLUSIONS Multiple IVG seemed to be beneficial for patients with CMV retinitis after stem-cell transplantation, in reducing CMV levels in aqueous humor. Further study to optimize the dose of ganciclovir is needed in order to achieve better treatment outcomes.
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Affiliation(s)
- Heng Miao
- Department of Ophthalmology, People's Hospital, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Peking University, 11 Xizhimen South Street, Xicheng District, 100044, Beijing, China
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Banait S, Jain J, Parihar PH, Karwassara V. Orbital tuberculosis manifesting as proptosis in an immunocompromised host. Indian J Sex Transm Dis AIDS 2012. [PMID: 23188941 DOI: 10.4103/0253-7184.102129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Orbital tuberculosis is an extremely rare, potentially devastating state, when not effectively treated, can lead to grave sequelae. Proptosis can be the result of primary orbital pathology or systemic disease processes. (1, 2) Thyroid ophthalmopathy being commonest cause of proptosis .It can also be a manifestation of, diseases involving various structures of orbit and of superior orbital fissure or cavernous sinus. A case of orbital tubercular abscess presenting with proptosis and blindness in a young male 27 years is reported. Clinicians should suspect rare causes in an immuno- compromised host .(2, 3) The failure to diagnose these conditions can lead to unintended sequelae. KEY MESSAGE The patient who presents with proptosis must be evaluated to ascertain the causation. Preservation of vision is of paramount importance. On follow-up patients should be monitored for complications and remedied.
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Affiliation(s)
- Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
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Banait S, Jain J, Parihar P, Karwassara V. Orbital tuberculosis manifesting as proptosis in an immunocompromised host. Indian J Sex Transm Dis AIDS 2012. [PMID: 23188941 PMCID: PMC3505291 DOI: 10.4103/2589-0557.102129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Orbital tuberculosis is an extremely rare, potentially devastating state, when not effectively treated, can lead to grave sequelae. Proptosis can be the result of primary orbital pathology or systemic disease processes. (1, 2) Thyroid ophthalmopathy being commonest cause of proptosis .It can also be a manifestation of, diseases involving various structures of orbit and of superior orbital fissure or cavernous sinus. A case of orbital tubercular abscess presenting with proptosis and blindness in a young male 27 years is reported. Clinicians should suspect rare causes in an immuno- compromised host .(2, 3) The failure to diagnose these conditions can lead to unintended sequelae. KEY MESSAGE The patient who presents with proptosis must be evaluated to ascertain the causation. Preservation of vision is of paramount importance. On follow-up patients should be monitored for complications and remedied.
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Affiliation(s)
- Shashank Banait
- Department of Ophthalmology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Jyoti Jain
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India,Address for correspondence: Dr. Jyoti Jain, Department of Medicine, Mahatma Gandhi institute of medical sciences, Sewagram, Wardha, Maharashtra - 442 102, India. E-mail:
| | - P.H. Parihar
- Department of Radiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
| | - Vikas Karwassara
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India
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Heier JS, Antoszyk AN, Pavan PR, Leff SR, Rosenfeld PJ, Ciulla TA, Dreyer RF, Gentile RC, Sy JP, Hantsbarger G, Shams N. Ranibizumab for treatment of neovascular age-related macular degeneration: a phase I/II multicenter, controlled, multidose study. Ophthalmology 2006; 113:633.e1-4. [PMID: 16483659 DOI: 10.1016/j.ophtha.2005.10.052] [Citation(s) in RCA: 251] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/14/2005] [Accepted: 10/20/2005] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess safety of repeated intravitreal injections of ranibizumab in treating neovascular age-related macular degeneration (AMD), and to assess changes in visual acuity (VA) and AMD lesion characteristics. DESIGN Multicenter, controlled, open-label, clinical trial. PARTICIPANTS Sixty-four patients with subfoveal predominantly or minimally classic AMD-related choroidal neovascularization. METHODS In part 1, subjects were randomized to monthly intravitreal ranibizumab for 3 months (4 injections of 0.3 mg or 1 injection of 0.3 mg followed by 3 injections of 0.5 mg; n = 53) or usual care (UC; n = 11). In part 2, subjects could continue their regimen for 3 additional months or cross over to the alternative treatment. MAIN OUTCOME MEASURES Adverse events (AEs), intraocular pressure (IOP), VA, and lesion characteristics assessed by fluorescein angiography and fundus photography. RESULTS Of the 64 randomized subjects, 62 completed the 6-month study. Twenty of 25 subjects (80%) randomized to 0.3 mg, and 22 of 28 subjects (79%) randomized to 0.5-mg ranibizumab in part 1 continued on that treatment in part 2; 9 of 11 (82%) subjects randomized to UC in part 1 crossed over to ranibizumab treatment in part 2. The most common AEs with ranibizumab were reversible inflammation and minor injection-site hemorrhages. Serious AEs were iridocyclitis, endophthalmitis, and central retinal vein occlusion (1 subject each). Postinjection, IOP increased transiently in 22.6% of ranibizumab-treated eyes in parts 1 and 2. After 4 ranibizumab injections (day 98), mean (+/- standard deviation) VA had increased 9.4+/-13.3 and 9.1+/-17.2 letters in the 0.3- and 0.5-mg groups, respectively, but had decreased 5.1+/-9.6 letters with UC. In part 2 (day 210), VA increased from baseline 12.8+/-14.7 and 15.0+/-14.2 letters in subjects continuing on 0.3 and 0.5 mg, respectively. Visual acuity improved from baseline > or =15 letters in 26% (day 98) and 45% (day 210) of subjects initially randomized to and continuing on ranibizumab, respectively, and areas of leakage and subretinal fluid decreased. No UC subject had a > or =15-letter improvement at day 98. CONCLUSIONS Repeated intravitreal injections of ranibizumab had a good safety profile and were associated with improved VA and decreased leakage from choroidal neovascularization in subjects with neovascular AMD.
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Affiliation(s)
- Jeffrey S Heier
- Ophthalmic Consultants of Boston, Boston, Massachusetts 02114, USA
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Lee JJ, Teoh SCB, Chua JLL, Tien MCH, Lim TH. Occurrence and reactivation of cytomegalovirus retinitis in systemic lupus erythematosus with normal CD4 counts. Eye (Lond) 2005; 20:618-21. [PMID: 15920561 DOI: 10.1038/sj.eye.6701941] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bert RJ, Samawareerwa R, Melhem ER. CNS MR and CT findings associated with a clinical presentation of herpetic acute retinal necrosis and herpetic retrobulbar optic neuritis: five HIV-infected and one non-infected patients. AJNR Am J Neuroradiol 2004; 25:1722-9. [PMID: 15569737 PMCID: PMC8148741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION This report demonstrates the spectrum of central nervous system (CNS) abnormalities observed on MR imaging and CT studies in 6 patients with clinical or pathologic diagnoses of acute retinal necrosis (ARN) and retrobulbar optic neuritis (RBON-H) resulting from Herpes Zoster Virus and Cytomegalovirus. We discuss the etiologic and pathophysiologic implications regarding these findings. METHODS Standard MR imaging sequences of the whole brain and selected high-resolution images of the orbits and globes, from 6 patients, were reviewed by three neuroradiologists for consensus interpretation of the findings. Special sequences augmenting disease were obtained in individual cases. Axial CT images were obtained from two patients using 5mm sequential slices. RESULTS MR imaging findings showed both T2 signal brightening and contrast enhancement in one or both optic nerves, optic tracts and lateral geniculate bodies, as well as the postsynaptic optic radiations and optic cortex. Similar findings were observed in the superior colliculus, lateral midbrain and cerebellum, with multiple potential etiologic possibilities regarding pathways of dissemination. Low T2* signal (indicating magnetic field susceptibility effects) and CT hyperdensity, consistent with prior hemorrhage, were also observed in the optic tracts, optic radiations and lateral geniculate bodies. Post-contrast enhancement was observed in the meninges and Meckle's cave in one HIV negative patient. CONCLUSION These cases demonstrate CNS imaging findings associated with RBON that are temporally-related to ARN. They support the hypothesis that RBON can either precede or follow ARN and implicate transneuronal, transsynaptic and/or transcerebrospinal fluid viral spread by the herpetic family.
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Wolf DL, Rodríguez CA, Mucci M, Ingrosso A, Duncan BA, Nickens DJ. Pharmacokinetics and renal effects of cidofovir with a reduced dose of probenecid in HIV-infected patients with cytomegalovirus retinitis. J Clin Pharmacol 2003; 43:43-51. [PMID: 12520627 DOI: 10.1177/0091270002239705] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To reduce possible nephrotoxicity, intravenous prehydration with normal saline and administration of probenecid must be used with each infusing of the antiviral cidofovir. The recommended standard-dose probenecid (SDP) regimen is 2 g at 3 hours before cidofovir, then 1 g at 2 and 8 hours after cidofovir (total 4 g). A new regimen of reduced-dose probenecid (RDP), 2 g at 1 hour before cidofovir without additional probenecid administrations after infusion (total 2 g), was compared with SDP using a randomized, open-label, parallel design. A single dose of cidofovir (5 mg/kg) was given as a 1-hour infusion after saline prehydration to 24 HIV-infected patients (11 males, 13 females) with cytomegalovirus retinitis and good renal function. Blood was sampled for 48 hours and urine for 24 hours after the start of the cidofovir infusion. Cidofovir pharmacokinetics did not differ significantly between groups. Average key pharmacokinetic parameters (Cmax, tmax, lambda z, AUC0-infinity, Vss, CL, CLR, fe, ER) for RDP differed by less than 17% from SDP and were consistent with previously reported SDP data. Renal function parameters, other safety endpoints, and adverse events were similar between the groups. Therefore, the reduced-dose regimen of probenecid provided renal protection after a single dose of cidofovir and did not alter the pharmacokinetics of cidofovir in patients with moderately good renal function. Although the overall pharmacokinetic results do not show a significant difference in cidofovir exposure with the new probenecid regimen, the main issue of safety of the new dose regimen, both relating to renal toxicity and probenecid-related adverse events, is not adequately addressed in a small study.
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