Kyrieleis plaques in cytomegalovirus retinitis

Amar Patel,Matthew Pomykala,Krishna Mukkamala,Ronald C Gentile

doi:10.1007/s12348-011-0033-y

Abstract

PurposeThe purpose of this study is to report a case of Kyrieleis plaques (segmental retinal periarteritis) associated with cytomegalovirus (CMV) retinitis.MethodsA 47-year-old female with recently diagnosed human immunodeficiency virus and a CD4 count of 55 cells/µl presented with decreased vision and floaters in her left eye. Ophthalmic examination revealed an advancing border of white granular CMV retinitis extending into the macula. Intraocular aqueous specimen contained 420,000 copies/ml of CMV DNA by polymerase chain reaction. The patient was treated with intravitreal foscarnet and oral valganciclovir.ResultsKyrieleis plaques involving the retinal arteries were noted on presentation and increased during the first 6 weeks of treatment as the retinitis faded. The plaques on fluorescein angiography did not leak fluorescein dye and slowly faded over 5 months.ConclusionsKyrieleis plaques can be seen in the setting of CMV retinitis. These plaques can be differentiated from vascular sheathing and frosted branch angiitis by its occurrence only in the retinal arteries and the absence of leakage of fluorescein dye.

Highlights

Kyrieleis plaques, referred to as segmental retinal periarteritis, were first described in an eye with tuberculosis uveitis by Kyrieleis in 1933 [1]
They have been reported with Rickettsia conorii, Mycobacterium tuberculosis, Treponema pallidum, and varicella-zoster virus (VZV) infections [1, 3,4,5,6,7]
Kyrieleis plaques seen on Laboratory evaluation revealed an elevated serum CMV IgG antibody with a negative systemic work up for T. gondii, VZV, herpes simplex virus (HSV), T. pallidum, and tuberculosis

Summary

Introduction

Referred to as segmental retinal periarteritis, were first described in an eye with tuberculosis uveitis by Kyrieleis in 1933 [1]. In 1959, Griffin and Bodian used the term segmental retinal periarteritis to describe them [2]. These plaques appear as whitish, segmented deposits found within the walls of the retinal arteries.

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