Cytomegalovirus Retinal Necrosis With Occlusive Vasculopathy Secondary to Steroid Immunosuppression for Giant Cell Arteritis.

Autor:	Zeng A; East Bay Retina Consultants Inc, Oakland, CA, USA., Strauss R; Private Medical, San Francisco, CA, USA., Goglin SE; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA., Gonzales J; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.; Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA., Pawar VK; Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA., Imes RK; Department of Ophthalmology, Sutter Health, California Pacific Medical Center, San Francisco, CA, USA., Jung JJ; East Bay Retina Consultants Inc, Oakland, CA, USA.; Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
Jazyk:	angličtina
Zdroj:	Journal of vitreoretinal diseases [J Vitreoretin Dis] 2020 Feb 26; Vol. 4 (3), pp. 227-232. Date of Electronic Publication: 2020 Feb 26 (Print Publication: 2020).
DOI:	10.1177/2474126420908717
Abstrakt:	Purpose: This case report discusses an atypical case of cytomegalovirus (CMV) retinal necrosis with panretinal occlusive vasculopathy in a 77-year-old man who was immunosuppressed following treatment for giant cell arteritis (GCA). Methods: A case report is presented. Results: Clinical examination demonstrated a central retinal artery occlusion and pale disc suspicious for arteritic ischemic optic neuropathy in the right eye. Biopsy-proven GCA prompted treatment with oral prednisone. While on glucocorticoid immunosuppression, the patient suffered vision loss in the left eye from CMV-necrotizing retinitis with occlusive vasculopathy. Treatment controlled the CMV infection but tapering of his steroids resulted in worsening GCA, requiring a steroid-sparing treatment, tocilizumab. Conclusions: Corticosteroid immunosuppression for GCA may lead to immune dysfunction allowing for an atypical occlusive vasculitis with retinal necrosis from CMV. Early identification and treatment are essential to adjust the level of immunosuppression and consider alternate therapies to control the GCA and prevent worsening of this opportunistic infection. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s) 2020.)
Databáze:	MEDLINE
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