Volume 202 - Issue 8
Cytomegalovirus disease in immunocompetent adults
Authors: Enis D Kocak, Justin C Sherwin and Anthony J Hall
Med J Aust 2015; 202 (8): 419. || doi: 10.5694/mja14.01704
Published online: 4 May 2015
Published online: 4 May 2015
This topic has garnered increased recognition in the eye care community
To the Editor: We read with interest the review by Lancini and colleagues on cytomegalovirus (CMV) in immunocompetent patients.1 This topic and its associations with ocular disease has garnered increased recognition in the eye care community.
Clinically, CMV can cause an anterior uveitis (iritis) or, more rarely, retinitis, in otherwise healthy patients.2 The uveitis typically features a chronic and/or recurrent course with anterior segment inflammation, keratic precipitates, endotheliitis, iris atrophy and elevated intraocular pressure (IOP).3 CMV retinitis is characterised by confluent or semiconfluent areas of retinal whitening with haemorrhage.4
As with systemic CMV disease, oral valganciclovir appears to be effective treatment for ocular disease.3-5 CMV-associated ocular disease in immunocompetent adults is underdiagnosed due to low clinical suspicion and its capacity to mimic inflammatory eye disease associated with other Herpesviridae such as herpes simplex virus or varicella zoster virus.3,5 Misdiagnosis as other Herpesviridae can result in antiviral treatment that is ineffective in CMV disease. Thus, CMV ocular disease should be considered as a differential diagnosis in immunocompetent patients presenting with chronic unilateral anterior uveitis or retinitis. Where suspected, an anterior and/or vitreous chamber paracentesis with viral polymerase chain reaction (PCR) analysis should be performed for definitive diagnosis.3
A recent case illustrates this diagnostic challenge. A 53-year-old immunocompetent and systemically well man presented with a unilateral chronic anterior uveitis and elevated IOP. Treatment with topical corticosteroid eyedrops was commenced for non-infectious uveitis. After a poor response, an anterior chamber paracentesis was performed, which tested positive for CMV (on PCR). The uveitis subsequently became quiescent with oral valganciclovir.
Competing interests
No relevant disclosures.
References
- Lancini D, Faddy HM, Flower R, et al. Cytomegalovirus disease in immunocompetent adults. Med J Aust 2014; 201: 578-580. 1
- Rafailidis PI, Mourtzoukou EG, Varbobitis IC, et al. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008; 5: 47. 2
- Chee SP, Bacsal K, Jap A, et al. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Am J Ophthalmol 2008; 145: 834-840. 3
- Radwan A, Metzinger JL, Hinkle DM, et al. Cytomegalovirus retinitis in immunocompetent patients: case reports and literature review. Ocul Immunol Inflamm 2013; 21: 324-328. 4
- van Boxtel LA, van der Lelij A, van der Meer J, et al. Cytomegalovirus as a cause of anterior uveitis in immunocompetent patients. Ophthalmology 2007; 114: 1358-1362. lefthere