EBV+ posttransplant lymphoproliferative disease of the retina presenting as cytomegalovirus retinitis
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LETTER TO THE EDITOR
EBV+ posttransplant lymphoproliferative disease of the retina presenting as cytomegalovirus retinitis Ian Y. Wong 1,2,3 & Wing-Lau Ho 1 & Lawrence P. Iu 4 & Ken H. P. Lau 5 & Pak-Leung Ho 6 & Yok-Lam Kwong 7 Received: 12 September 2020 / Accepted: 28 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, A 29-year-old woman with acute lymphoblastic leukaemia underwent an allogeneic haematopoietic stem cell transplantation (HSCT) from a voluntary unrelated (7/8 HLA-matched) donor in January 2015. There was grade II acute skin graftversus-host disease (GVHD), which responded to corticosteroids. Post-HSCT, immunosuppression comprised tapering doses of cyclosporine and mycophenolate mofetil. At 2 months, she developed asymptomatic cytomegalovirus (CMV) viraemia, successfully treated with intravenous foscarnet followed by oral valganciclovir. In May 2015, she presented with blurring of right eye vision. Her visual acuity (VA) was 20/200 in the right and 20/20 in the left. Examination of the right eye showed normal anterior chamber, but two patches of retinitis inferior to the optic disc, associated with haemorrhages and disc swelling (Fig. 1a). The left eye was normal. Right eye aqueous aspirate tested positive by polymerase chain reaction (PCR) for CMV at 2.4 × 103 copies/mL, but negative for varicella zoster virus (VZV) and herpes simplex virus (HSV). There was no concomitant CMV viraemia. CMV retinitis was diagnosed, and * Yok-Lam Kwong [email protected] 1
Department of Ophthalmology, Grantham Hospital, Hong Kong, China
2
Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China
3
Department of Ophthalmology, University of Hong Kong, Hong Kong, China
4
Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
5
Department of Pathology, Queen Mary Hospital, Hong Kong, China
6
Department of Microbiology, Queen Mary Hospital, Hong Kong, China
7
Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
intravitreal ganciclovir (2 mg) and intravenous foscarnet were administered. Vision did not improve, with retinitis worsening (Fig. 1b) and VA decreasing to 20/1200. Intravitreal treatment was escalated to ganciclovir (2 mg) plus foscarnet (2.4 mg), administered twice weekly. However, retinitis progressively deteriorated despite treatment (Fig. 1 c and d). These atypical features prompted further investigations. A magnetic resonance imaging (MRI) of the right eye performed 6 weeks after presentation showed mild enhancement of the retina close to the optic disk (Fig. 1e). Cerebrospinal fluid (CSF) was acellular with normal biochemistry. She was maintained on oral valganciclovir, with no improvement in right eye vision. Eight weeks after presentation, localised retinal detachment and vitreous haemorrhage developed, with VA decreasing to light perception (Fig. 1f). Vitrectomy, endolaser and silicone oil injection were performed. A choroidal mass at the optic disc was noted intra
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