Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy

Aditya Kelkar,Jai Kelkar,Shreekant Kelkar,Jyotirmoy Biswas,Shilpa Bhirud

doi:10.1007/s12348-010-0017-3

Aditya Kelkar, Jai Kelkar + Show 3 more

Open Access

https://doi.org/10.1007/s12348-010-0017-3

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Abstract

AimThe purpose of this study is to report a rare case of cytomegalovirus (CMV) retinitis in a seronegative patient with systemic lupus erythematosus (SLE) on immunosuppressive therapy.MethodsA seronegative patient with SLE who was on immunosuppressive therapy developed CMV retinitis. The immunosuppressive therapy was tapered, and the patient was given intravitreal ganciclovir and foscarnet in addition to systemic ganciclovir. The follow-up visits were documented.ResultThe patient responded to the treatment and there was complete resolution.ConclusionCMV retinitis is a rapidly progressive condition and patients on immunosuppressive therapy should be referred to an ophthalmologist for periodic check-up for early diagnosis and treatment of this devastating ophthalmic condition. For clinically resistant CMV retinitis in seronegative patients with SLE, a combination therapy of intravitreal foscarnet with oral and intravenous ganciclovir is useful.

Highlights

Systemic lupus erythematosus (SLE) is not generally considered a predisposing factor for cytomegalovirus (CMV) retinitis
Immunosuppressive therapy may have a role in the development of CMV retinitis in these patients [1]
We report a case of bilateral CMV retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy for grade 4 lupus nephritis

Summary

Introduction

Systemic lupus erythematosus (SLE) is not generally considered a predisposing factor for cytomegalovirus (CMV) retinitis. We report a case of bilateral CMV retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy for grade 4 lupus nephritis. In 2007, the patient had developed fever, skin rashes, nausea, breathing difficulty, polyarthralgias and myalgias She had been admitted to a hospital and had been diagnosed as SLE based on clinical presentation and investigation results which were as follows: anti-DNA positive (3.68); proteinuria, 4+; raised 24-h urine protein, 5,432 mg/24 h (21.3–119.6 mg/24 h); ANA positive (1.56); Ro-52 positive; raised C-reactive protein level, 30 mg/ L. The renal biopsy showed diffuse proliferative glomerulonephritis with capillary wall thickening consistent with lupus nephritis (WHO class IV) with activity index, 04; chronicity index, 01 She had been given intravenous methyl prednisolone 1 g daily for 1 week, azathioprine tablet 50 mg twice a day, hydroxychloroquine tablet 200 mg twice a day and

Objectives

Conclusion