PMC7734499_01
Clinical course of patient with CMV retinitis following allogeneic HSCT. Day 0 indicates the day of transplantation. The solid line indicates the CMV viral load in whole blood.. CMV, cytomegalovirus; CMVR, CMV retinitis; HSCT, hematopoietic stem cell transplantation; VGCV, valgancyclovir.
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Second line treatment with foscarnet 120 mg/kg was started promptly, leading to a slow decrease of viral load up to 25,800 UI/ml after 2 weeks of treatment (Figure 1). The patient was treated with a combination of foscarnet 120mg/kg and VGCV 450 mg bid, resulting in the clearance of CMV DNAemia after 2 weeks of treatment (Figure 1). Cyclosporine was tapered and then stopped on day + 315 (Figure 1).
Fundoscopic finding at the time of initial diagnosis (day+160 after transplantation). Evolutionary CMVR with initial vitreitis, optic papilla hyperaemia, peripheral/equatorial retinal necrosis, retinal haemorrhages, retinal oedema, retinal vasculitis.. CMV, cytomegalovirus; CMVR, CMV retinitis.
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Fundoscopy revealed papillary hyperaemia, retinal necrosis, haemorrhage and vasculitis consistent with CMVR (Figure 2), although whole blood CMV DNAemia was negative.
(A) OCT 3 months after the end of systemic and local antiviral treatment. Regression of CMVR with persistence only of increased central retinal thickness. (B) Retinal fluoroscopy 3 months after the end of systemic and local antiviral treatment.. CMV, cytomegalovirus; CMVR, CMV retinitis; LE, left eye; OCT, optical coherence tomography; RE, right eye.
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At 7 months after the diagnosis of CMV retinitis, the patient is in good general conditions and in continuous haematological remission (Figure 3).