Dual Retinitis with Cytomegalovirus and Herpes Simplex in a Paediatric Patient with Advanced Retinoblastoma: A Case Report
DOI:
https://doi.org/10.48560/rspo.33251Keywords:
Child, Cytomegalovirus Retinitis, Eye Infections, Viral, Herpes Simplex, Molecular Biology, RetinoblastomaAbstract
Herpesvirus retinitis is a serious infection of the retina typically found in immunosuppressed patients. We report the case of a 4-year-old boy with a history of enucleation of the left eye for intraocular advanced retinoblastoma, at time under systemic adjuvant chemotherapy, observed under anaesthesia for periodic disease follow-up. Right eye fundus evaluation showed multiple areas of focal haemorrhagic retinitis without retinal necrosis along the mid and far periphery. Aqueous and peripheral blood polymerase chain reaction revealed dual positivity for cytomegalovirus and herpes simplex virus type 1. The patient was managed with three intravitreal foscarnet injections, intravenous ganciclovir and foscarnet and the lesions gradually regressed. However, two months later, a reactivation of retinitis lesions occurred and four additional intravitreal foscarnet injections were needed. In cases of suboptimal therapeutic response or atypical retinitis presentations, we believe that prompt molecular analysis of ocular fluids for viral DNA detection is crucial to correctly identify the causative agent.
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Gueudry J, Bodaghi B. Advances in the microbiological diagnosis of herpetic retinitis. Front Ophthalmol. 2022;2:1-10. doi: 10.3389/fopht.2022.990240
Han MS, Choi EH, Lee HJ, Yun KW, Kang HJ, Hong KT, et al. Cytomegalovirus disease in a retinoblastoma cohort: The role of preemptive screening. Pediatr Blood Cancer. 2020;67:e28101. doi: 10.1002/pbc.28101
Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Cytomegalovirus Retinitis. Am J Ophthalmol. 2021;228:245–54. doi: 10.1016/j.ajo.2021.10.020.
Bodaghi B, Rozenberg F, Cassoux N, Fardeau C, LeHoang P. Nonnecrotizing herpetic retinopathies masquerading as severe posterior uveitis. Ophthalmology. 2003;110:1737–43. doi: 10.1016/S0161-6420(03)00580-3.
Fox GM, Crouse CA, Chuang EL, Pflugfelder SC, Cleary TJ, Nelson SJ, et al. Detection of herpesvirus DNA in vitreous and aqueous specimens by the polymerase chain reaction. Arch Ophthalmol. 1991;109:266–71.
Samanta R, Puthalath AS, Sood G, Singh R, Dogra M. Macular dual retinitis with herpes simplex and cytomegalovirus following periocular corticosteroid in a patient of pemphigus vulgaris. Eur J Ophthalmol. 2021;11206721211052848. doi: 10.1177/11206721211052847.
TNM8: The updated TNM classification for retinoblastoma. Community Eye Health. 2018;31:34.
Bigagli E, Agostiniani S, Pugi A, Rombi B, Tornaboni EE, Censullo ML, et al. Unforeseen cytomegalovirus retinopathy following high dose thiotepa and proton irradiation in a pediatric patient with high-risk medulloblastoma: A case report. Front Pediatr. 2023;11:1145941. doi: 10.3389/fped.2023.1145941.
Ljungman P, de la Camara R, Robin C, Crocchiolo R, Einsele H, Hill JA, et al. Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19:e260–72. doi: 10.1016/S1473-3099(19)30107-0.
Young S, McCluskey P, Minassian DC, Joblin P, Jones C, Coroneo MT, et al. Retinal detachment in cytomegalovirus retinitis: intravenous versus intravitreal therapy. Clin Experiment Ophthalmol. 2003;31:96–102.
Arenas-Canchuja F, Campos-Dávila B, Valderrama-Albino V. A case of non-necrotising herpetic retinitis. Arch Soc Esp Oftalmol. 2022;97:295–9. doi: 10.1016/j.oftale.2020.12.019.
Moharana B, Tekchandani U, Sharma SP, Kumar A, Singh R. Progressive outer retinal necrosis: Dual virus involvement. Indian J Ophthalmol. 2020;68:1955–6. doi: 10.4103/ijo.IJO_11_20.
Albert K, Masset M, Bonnet S, Willermain F, Caspers L. Long-term follow-up of herpetic non-necrotizing retinopathy with occlusive retinal vasculitis and neovascularization. J Ophthalmic Inflamm Infect. 2015;5:6. doi: 10.1186/s12348-015-0038-z.
Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol. 2009;147:140-7.e2. doi: 10.1016/j.ajo.2008.07.043.
Kharel Sitaula R, Janani MK, Madhavan HN, Biswas J. Outcome of polymerase chain reaction (PCR) analysis in 100 suspected cases of infectious uveitis. J Ophthalmic Inflamm Infect. 2018;8:2. doi: 10.1186/s12348-017-0144-1.
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