Bilateral acute necrotizing retinitis due to cytomegalovirus infection in an infant: Challenging case report

To report a case of bilateral acute necrotising retinitis due to cytomegalovirus infection (CMV) in an Asian Indian infant.

An Asian Indian infant born with a birth weight of 1000 g at 26 week of gestation acquired cytomegalovirus infection from repeated blood transfusion for anemia. During the routine course of ROP screening, both eyes were detected with Type 1 ROP (stage 3 in zone 1 with plus disease) and treated with laser photoablation at 39 + 2 weeks post menstrual age. The disease responded to the laser and showed signs of regression. Four weeks after laser therapy (PMA 43 + 3 weeks), both eyes presented with vitritis, inferior vitreous condensation and white lesions in the lower nasal retina and temporal retina overlying the lasered retinal bed associated with white fluffy hemorrhagic lesions resembling necrotising retinitis. As the infant was seropositive for CMV earlier, Necrotising retinitis due to CMV was suspected. The CMV DNA was repeated and was detected in serum. Infant was treated with anti-CMV medication (oral valgancyclovir) for six weeks. The retinal lesions resolved completely.

Bilateral acute necrotising retinitis may present in an infant on post lasered retina as early as 16 weeks after birth. CMV may also present as acute necrotising retinitis in unusual cases therefore high index of suspicion and early management can result in a successful outcome.