Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia

Abstract

A 62-years-old woman presented with microcytic hypochromic anemia, diffuse adenopathy, , and hepatosplenomegaly, was diagnosed as having Waldenst?m Macroglobulinemia by blood serum electrophoresis which detected a IgM-KAPPA monoclonal gammopathy, besides the results of immuno-phenotypic characteristics of neoplastic B-lymphocytes present in bone marrow positive for CD19, CD20, FMC7, CD79; and not reactive for CD23, CD5 and CD38. MYD88 mutation was absent. The patient underwent a week intermittent chemotherapy (oral scheme: Predinisone Session [CurrentTestPartID] mg and Chlorambucil 2 mg during 5 months) and then, without adequate therapeutic response, it was reset including intra-venous anti-CD20 monoclonal immunoglobulin (Rituximab, for 4 months). The patient had a good response to the therapy. However, almost a year after Rituximab scheme started, patient complained of sudden decrease of visual acuity (20/200) according to the Snellen chart with floaters, only in the left eye. CD4 T cell count was 205 cells/mm3, relatively reduced when compared to a health person because of the chronic use of immunosuppressant drugs and the down modulation due to the inflammatory stress state seen at a hematological lymphoproliferative disease. Fundoscopy findings were compatible with CMV retinitis , confirmed by CMV-DNA PCR in plasma samples with a high viremia (3.102 copies/mL). Plasma cytokines were measured to see the inflammatory response Intravenous Ganciclovir 500mg every 12 hours for 2 weeks was administered. Granulocyte colony-stimulating factor was used to manage neutropenia. Visual acuity improvement was observed (20/40).