Recurrent CMV Retinitis in a Daratumumab-Treated Multiple Myeloma Patient With Systemic Antiviral Intolerance

Area of Science:

• Ophthalmology
• Hematology
• Infectious Diseases

Background:

• Daratumumab-based chemotherapy is used for multiple myeloma.
• Cytomegalovirus (CMV) retinitis is a potential complication in immunocompromised patients.
• Systemic antiviral therapy can have significant side effects.

Purpose of the Study:

• To report a case of recurrent CMV retinitis in a multiple myeloma patient treated with daratumumab.
• To describe a treatment strategy for CMV retinitis in a patient with limited tolerance to systemic antivirals.

Main Methods:

• A case report of a 77-year-old male with relapsed multiple myeloma.
• Diagnosis of CMV retinitis confirmed by aqueous humor PCR.
• Treatment involved intravitreal antivirals and low-dose systemic valganciclovir due to intolerance to initial systemic therapy.

Main Results:

• The patient experienced recurrent CMV retinitis despite initial systemic valganciclovir and intravitreal foscarnet.
• Disease resolution was achieved with a combination of intravitreal ganciclovir and reduced-dose oral valganciclovir.
• This combined regimen was well tolerated by the patient.

Conclusions:

• Recurrent CMV retinitis is a rare but serious complication in patients receiving daratumumab.
• Ophthalmologic surveillance is crucial for early detection in immunocompromised patients.
• Flexible treatment approaches, including combined intravitreal and reduced-dose systemic antivirals, are important for patients intolerant to standard therapy.