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Updated: Feb 12, 2026
Comprehensive Analysis of Procoagulant Platelets Exhibiting Features of Necrosis, Apoptosis and Platelet Activation
Published on: May 23, 2025
Cytomegalovirus-associated Panretinal Occlusive Vasculopathy without Retinal Necrosis as the Heralding Feature of
Anand E Rajesh1, Justin J Grassmeyer1, Reid L Wilson1
1Casey Eye Institute, Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA.
Purpose:
To introduce an atypical occlusive panretinal vasculitis without necrotizing retinitis secondary to cytomegalovirus (CMV) infection as the heralding clinical event for a patient ultimately discovered to have Good Syndrome, a systemic immunodeficiency.
Methods:
Case report.
Results:
A 77-year-old male with a history of hypertension, diabetes mellitus, recurrent sinusitis, and oral thrush presented with 3 weeks of headaches and vision loss (20/250) in the right eye. Examination revealed panuveitis, scattered mid-peripheral intraretinal hemorrhages without retinal necrosis, profound retinal vascular nonperfusion, and elevated IOP due to anterior segment neovascularization. Aqueous humor viral PCR analysis revealed a high CMV viral load. Systemic evaluation was negative for HIV, CMV, toxoplasmosis, and syphilis; carotid duplex imaging was normal, leukemia and lymphoma studies were negative; and he was not neutropenic. CD4+ count and immunoglobulin levels were decreased, suggesting a combined B- and T-cell immunodeficiency. Computed tomography of the chest revealed a thymoma, consistent with Good Syndrome, a rare immunocompromising condition. Antiviral therapy did not significantly reverse retinal perfusion.
Conclusion:
Panretinal occlusive vasculitis without retinal necrosis is a rare phenotype of CMV retinitis. In HIV-negative patients with CMV retinitis, additional immunodeficiency workup is required, and rare combined immunodeficiencies such as Good Syndrome should be included on the differential.
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