Cytomegalovirus as a Cause of Corneal Endotheliitis in an Immunocompetent Patient

Abstract

Purpose: To report a case of Cytomegalovirus (CMV)-associated corneal endotheliitis in an immunocompetent patient and review the literature. Method: a case report. Results: A 68-year-old woman was referred to us with blurred vision and progressive corneal edema in the right eye for two months. Before referral, she was diagnosed as anterior uveitis complicated with elevated intraocular pressure (IOP) by a local practitioner. Even though IOP was controlled with antiglaucomatous medications, a progressive corneal edema developed and was refractory to medical treatments. We thus conducted a thorough rheumatologic survey, which however showed all negative results. Given that herpes simplex uveitis was suspected, systemic valaciclovir was given but in peril. Diagnostic anterior chamber tapping was performed and PCR detected the presence of CMV DNA in aqueous humor. Serum tests also showed positive result for CMV IgG but negative for CMV antigen and HIV. After receiving a single dose of intravitreal ganciclovir 2mg/0.1ml, the patient refused further systemic antiviral regimen for the concern of adverse effect. Six months later, the patient returned to complete a course of 3-month systemic valganciclovir treatment (900 mg p.o. twice daily for 6 weeks, followed by 450 mg twice daily for another 6 weeks); Despite the subside of viral infection by intensive anti-viral regimen, the irreversible endothelial damage resulted in persistent corneal edema. Conclusion: CMV infection should be included in the differential list of the causes of corneal endotheliitis. Aqueous humor analysis is crucial for the definitive diagnosis.