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

To describe a case of recurrent cytomegalovirus (CMV) retinitis in a patient undergoing daratumumab-based chemotherapy for multiple myeloma, with limited tolerance to systemic antiviral therapy.

Case report describing recurrent CMV retinitis in a patient on Daratumumab managed with a combination of intravitreal antivirals and low-dose systemic valganciclovir following systemic antiviral intolerance.

A 77-year-old man receiving daratumumab for relapsed multiple myeloma presented with blurred vision and was found to have CMV retinitis confirmed by aqueous humor PCR. Initial systemic valganciclovir led to partial improvement but was discontinued due to seizure presumed secondary to medication toxicity. The patient experienced recurrent disease despite prolonged intravitreal foscarnet therapy. Ultimately, disease resolution was achieved with combined intravitreal ganciclovir and reduced-dose oral valganciclovir, which was well tolerated.

CMV retinitis is a rare but serious complication in patients undergoing daratumumab-based therapy. This case highlights the importance of ophthalmologic surveillance and flexible treatment strategies in immunocompromised patients unable to tolerate full-dose systemic antiviral agents.