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Bilateral cytomegalovirus retinitis in a healthy infant
Seyedeh Maryam Hosseini1, Mir-Naghi Moosavi2, Naser Shoeibi1
1Eye Research Center, Khatam-al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Cytomegalovirus (CMV) retinitis can occur in healthy infants, even postnatally. Early detection and treatment of this serious CMV infection are crucial for potentially saving lives.
Area of Science:
- Ophthalmology
- Virology
- Pediatrics
Background:
- Cytomegalovirus (CMV) infection is a common cause of congenital disease, but retinitis is rare in immunocompetent infants.
- This case examines a rare instance of bilateral CMV retinitis in a previously healthy infant.
Observation:
- A four-month-old infant presented with visual inattention, fever, and agitation.
- Ophthalmic examination revealed bilateral panuveitis, retinitis, vasculitis, and retinal hemorrhages.
- CMV DNA was detected in ocular fluid and cerebrospinal fluid via PCR.
Findings:
- The infant, despite being immunocompetent, developed severe bilateral CMV retinitis and systemic CMV infection, likely transmitted from the mother.
- Treatment with intravitreal and systemic ganciclovir was initiated.
- The infant unfortunately succumbed to CMV encephalitis.
Implications:
- This case underscores the potential for cytomegalovirus retinitis in immunocompetent infants, even with postnatal transmission.
- A high index of clinical suspicion is vital for prompt diagnosis and management of CMV retinitis in infants.
- Timely intervention may be life-saving in cases of infant CMV infection.
Purpose:
To report a case of bilateral cytomegalovirus (CMV) retinitis in an otherwise healthy infant.
Methods:
A four-month-old, healthy, male infant was evaluated for visual inattention.
Results:
This full-term infant with a normal birth weight and an uneventful gestational period was referred with symptoms of visual inattention, fever, and agitation one week prior to admission. Ocular involvements were detected in the form of bilateral pan uveitis with diffuse bilateral retinitis and vasculitis with hemorrhage in the peripheral retina and posterior pole. CMV DNA was detected in the patient's ocular sample and cerebrospinal fluid by polymerase chain reaction (PCR). He was treated with intravitreal and systemic ganciclovir. Unfortunately, the infant died because of CMV encephalitis. Therefore, bilateral CMV retinitis (CMVR), which was probably transmitted from the mother, was diagnosed in this immunocompetent infant.
Conclusions:
The present case highlights the possibility of CMVR in immunocompetent infant associated with systemic CMV infection, even during the postnatal period. Therefore, a high index of clinical suspicion and prompt treatment may be life-saving in similar cases.