Atypical Retinal Lesion in a Heart Transplant Patient: Investigation and Management

A cardiac transplant patient presented to the Ochsner ophthalmology clinic with flashes of light in the left eye and a retinal lesion of unclear etiology.

A 59-year-old male cardiac transplant patient was referred by an outside eye physician. Examination of the anterior chamber of his left eye showed inflammation, and a large hypopigmented lesion was discovered in the nasal retina of the left eye. The patient was admitted to the hospital. Empiric treatment was initiated, and all workup results were negative. During the next several days, the patient's retinal lesion extended. A tap of the eye's vitreous and aqueous fluid yielded no diagnosis. The patient underwent a chorioretinal biopsy through a pars plana vitrectomy. Fluid removed from the vitreous cavity was sent for polymerase chain reaction (PCR) testing, and intravitreal antibiotics were injected. The results of the PCR were negative for all organisms. However, the lesion stabilized, and the patient has remained stable on oral valganciclovir.

Cytomegalovirus PCR testing has 95% sensitivity in untreated patients but only 48% sensitivity in patients treated with systemic ganciclovir, foscarnet, or both. Cytomegalovirus retinitis was determined to be a possible diagnosis; however, the possibility exists that the patient had developed a fungal subretinal abscess.