Journal of Pediatric Ophthalmology and Strabismus

Whats Your Diagnosis 

I Can't See

Ella H. Leung, MD; J. Timothy Stout, MD, PhD

Abstract

A 7-year-old boy with a history of acute myelogenous leukemia underwent bone marrow transplantation, total body radiation, and chemotherapy. He developed viremia with serum viral loads of 45,000 IU/mL. He was HIV negative. Funduscopy and optical coherence tomography initially revealed bilateral retinal whitening, retinal hemorrhages, attenuated retinal vasculature, chorioretinal atrophy, scarring in the fovea and macula, and blurred optic disc margins. Initial treatment with systemic valganciclovir was complicated by pancytopenia, and he was switched to foscarnet. He developed bone marrow suppression and was treated with serial intravitreal foscarnet and ganciclovir injections. Over the course of 2 years, he developed bilateral macula-off retinal detachments in both eyes (Figure 1A) for which he underwent pars plana vitrectomies, membrane peeling, and silicone oil implantation. His viremia resolved. He then underwent cataract extraction with intraocular lens implantations in both eyes. Three years after surgery, his retinas have remained attached (Figures 1B–1C), and the visual acuity has remained stable at 20/100 in the right eye and counting fingers in the left eye.

What's Your Diagnosis?

For the correct answer, see page 87.

The answer for What's Your Diagnosis? is acute myelogenous leukemia complicated by bilateral cytomegalovirus retinitis, retinal detachments, foveal atrophy, and cytomegalovirus optic neuropathy.…

A 7-year-old boy with a history of acute myelogenous leukemia underwent bone marrow transplantation, total body radiation, and chemotherapy. He developed viremia with serum viral loads of 45,000 IU/mL. He was HIV negative. Funduscopy and optical coherence tomography initially revealed bilateral retinal whitening, retinal hemorrhages, attenuated retinal vasculature, chorioretinal atrophy, scarring in the fovea and macula, and blurred optic disc margins. Initial treatment with systemic valganciclovir was complicated by pancytopenia, and he was switched to foscarnet. He developed bone marrow suppression and was treated with serial intravitreal foscarnet and ganciclovir injections. Over the course of 2 years, he developed bilateral macula-off retinal detachments in both eyes (Figure 1A) for which he underwent pars plana vitrectomies, membrane peeling, and silicone oil implantation. His viremia resolved. He then underwent cataract extraction with intraocular lens implantations in both eyes. Three years after surgery, his retinas have remained attached (Figures 1B–1C), and the visual acuity has remained stable at 20/100 in the right eye and counting fingers in the left eye.

What's Your Diagnosis?

For the correct answer, see page 87.

The answer for What's Your Diagnosis? is acute myelogenous leukemia complicated by bilateral cytomegalovirus retinitis, retinal detachments, foveal atrophy, and cytomegalovirus optic neuropathy.

References

  1. Vishnevskia-Dai V, Shapira Y, Rahav G, Shimoni A, Somech R, Moisseiev J. Cytomegalovirus retinitis in HIV-negative patients: a practical management approach. Ophthalmology. 2015;122:866–868. doi:10.1016/j.ophtha.2014.11.010 [CrossRef]
  2. Carmichael A. Cytomegalovirus and the eye. Eye (Lond). 2012;26:237–240. doi:10.1038/eye.2011.327 [CrossRef]
  3. Research Group in Collaboration with the AIDS Clinical Trials Group (ACTG). Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of AIDS (SOCA) Research Group in Collaboration with the AIDS Clinical Trials Group (ACTG). Am J Ophthalmol. 1997;124:61–70. doi:10.1016/S0002-9394(14)71645-9 [CrossRef]
Authors

From the Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Ella H. Leung, MD, Department of Ophthalmology, Baylor College of Medicine, 1977 Butler Blvd., Houston, TX 77030. E-mail: ehleung@bcm.edu

10.3928/01913913-20190212-01

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