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Chronic cytomegalovirus necrotising retinitis: case report A 52-year-old woman developed chronic cytomegalovirus (CMV) necrotising retinitis of the right eye (RE) during immunosuppressive therapy with hydroxychloroquine, mycophenolate and prednisone. The woman, who had scleroderma, mixed connective tissue disease, hypothyroidism due to chronic lymphocytic thyroiditis, diffuse interstitial pneumonia and severe malnutrition, had been receiving treatment with mycophenolate 1000mg every 8h, prednisone 5 mg/day and hydroxychloroquine 200mg every 12h for 4 years [routes not stated]. During the routine check-up, she was found to have visual acuity (VA) of 1.0 in the left eye (LE) and 0.1 in the RE. A yellowish-white granular infiltrate was noted at the bottom of her RE in the temporal semicircle at the fovea. Optical coherence tomography (OCT) showed several cystic cavities in the outer and middle layers of the retina. Above these cavities (in the inner retina), an area of hyper-reflectivity was observed, which corresponded to the granular semicircular area. She was diagnosed with macular hole in the RE. Four weeks later, she underwent surgery including 25G pars plana vitrectomy, peeling of the inner limiting membrane (ILM), 20% of sulfur hexafluoride [SF6] and inverted ILM flap. At 4 weeks, a closed flat closure was noted with VA of counting fingers at 50cm. However, spread of the granular lesions to other areas of the macular with mild vitritis and atrophy of the central macular area was observed. After 1 month, an extension of the granular lesions with haemorrhages, central atrophy of the macula, arterial sheathing in the posterior pole and arterial and venous occlusions was observed. Fluorescein angiography (FA) demonstrated venous and arterial fragmentation and occlusion. Considering the findings, initial diagnosis of macular hole was reconsidered, and CMV retinitis was suspected. Serology test was positive for CMV, Epstein-Barr virus and Herpes simplex virus type 1 (HSV-1). PCR testing of the vitreous and aqueous humour confirmed CMV and excluded HZV and HSV. She also had leukocytopenia with lymphocyte count of 0.4 × 109/L. The woman was started on treatment with valganciclovir and ganciclovir. After consultation with infectious diseases department, other infections were ruled out. Because of malabsorption secondary to oesophageal involvement due to disease, she was admitted and received IV treatment. She was also started on parenteral nutrition. After improvement in her general condition, oral treatment with valganciclovir was started. After 30 days of treatment initiation, clear improvement in her retinitis was noted. However, a significant atrophy of the macula persisted. Subsequently, her infection resolved. Her final VA of the RE was counting fingers [time to reactions onset not stated]. Lopez-Herrero F, et al. Chronic cytomegalovirus necrotising retinitis in a patient with scleroderma and mixed connective tissue disease. Archivos de la Sociedad Espanola de 803497497 Oftalmologia : 9 Jul 2020 [Spanish; sum