Cytomegalovirus Retinitis: Can It Occur with Normal CD4 Counts and Be Misdiagnosed as Retinal Vein Occlusion?
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Purpose
To describe a case of cytomegalovirus (CMV) retinitis in a patient with preserved CD4 counts that was misdiagnosed as retinal vein occlusion (RVO) and initially treated with anti-VEGF therapy.
Methods
Case report.
Results
A 29-year-old male presented with progressive bilateral visual loss over two months. He was initially evaluated and treated at another institution with intravitreal anti-VEGF (bevacizumab) in the right eye (OD) for a presumed diagnosis of RVO. Further ophthalmologic evaluation revealed severe vision loss (hand motion in OD and counting fingers in the left eye [OS]). Fundus examination showed an atrophic retina with residual hemorrhages in OD and typical CMV retinitis lesions with a "cheese and ketchup" appearance and blurred optic disc in OS. Laboratory testing confirmed HIV infection and a clinical diagnosis of CMV retinitis was made, despite a CD4 count consistently above 200 cells/μL. The patient was treated with intravenous ganciclovir and antiretroviral therapy (ART). Post-treatment, visual acuity improved to 20/40 partial in OS, while OD, which had received anti-VEGF therapy, showed no improvement and remained at hand motion.
Conclusion
This case highlights the possibility of CMV retinitis presenting in patients with preserved CD4 counts and being misdiagnosed as RVO. It also underscores the potential for worse outcomes in eyes treated inappropriately with anti-VEGF therapy. Recognizing opportunistic infections in atypical retinal presentations is critical to ensuring accurate and timely diagnosis, optimizing visual and systemic outcomes.
Conflict of interest
No
1
Last name
OLIVEIRA
Initials of first name(s)
F M
Department
UNIFESP Ophthalmology Department
City
São Paulo
Country
Brazil
2
Last name
SOUZA
Initials of first name(s)
C E
Department
UNIFESP Ophthalmology Department
City
São Paulo
Country
Brazil
3
Last name
MACEDO
Initials of first name(s)
G
Department
UNIFESP Ophthalmology Department
City
São Paulo
Country
Brazil
4
Last name
ABRÃO
Initials of first name(s)
P
Department
UNIFESP Infectology Department
City
São Paulo
Country
Brazil
5
Last name
MUCCIOLI
Initials of first name(s)
C
Department
UNIFESP Ophthalmology Department
City
São Paulo
Country
Brazil
6
Last name
FINAMOR
Initials of first name(s)
L P
Department
UNIFESP Ophthalmology Department
City
São Paulo
Country
Brazil
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