Kawai Y, Kawai R, Nakayama T, Tanizawa A, Urasaki Y, Fukushima T, Yoshida A, Yamauchi T, Tsutani H, Wano Y, Akagi Y, Ueda T
First Department of Internal Medicine, Fukui Medical University, Matsuoka, Japan.
Int J Hematol. 1999 Jun;69(4):256-9.
A 52-year-old Japanese woman was diagnosed as having angioimmunoblastic T-cell lymphoma (stage IV-B). She received 6 courses of chemotherapy including cyclophosphamide, doxorubicin, vincristine, and prednisolone every two weeks (biweekly CHOP), and was considered to be in partial remission. She complained of loss of visual acuity in her right eye during her last cycle of chemotherapy. Cytomegalovirus (CMV) retinitis was suspected from the characteristic ophthalmoscopic appearance. This diagnosis was further supported by the detection of CMV DNA in blood and antigens in polymorphonuclear leukocytes, a sign of CMV reactivation. Although DNAemia and antigenemia became negative, retinitis remained slightly active despite a 4-week systemic treatment of ganciclovir. Intraocular injection of ganciclovir was started and continued until the retinitis became inactive ophthalmoscopically. The patient received high-dose chemotherapy with peripheral blood stem cell transplantation and achieved complete remission. During the after this therapy no recurrence of CMV infections was observed. This case shows that 1) a quick and accurate diagnosis of CMV retinitis was possible by applying DNAemia and antigenemia and 2) intensive treatment for the CMV infection enabled the accomplishment of cure-oriented chemotherapy of the lymphoma without the recurrence of CMV retinitis.
一名52岁的日本女性被诊断为血管免疫母细胞性T细胞淋巴瘤（IV - B期）。她每两周接受6个疗程的化疗，包括环磷酰胺、阿霉素、长春新碱和泼尼松龙（双周CHOP方案），并被认为处于部分缓解状态。在她最后一个化疗周期中，她抱怨右眼视力下降。根据特征性的眼底镜表现怀疑为巨细胞病毒（CMV）视网膜炎。血液中CMV DNA的检测以及多形核白细胞中抗原的检测进一步支持了这一诊断，这是CMV重新激活的迹象。尽管病毒血症和抗原血症转阴，但在接受4周的更昔洛韦全身治疗后，视网膜炎仍有轻微活动。开始进行玻璃体内注射更昔洛韦并持续至眼底镜检查显示视网膜炎不再活动。患者接受了高剂量化疗及外周血干细胞移植并实现了完全缓解。在此治疗后的随访期间未观察到CMV感染复发。该病例表明：1）通过检测病毒血症和抗原血症能够快速准确地诊断CMV视网膜炎；2）对CMV感染进行强化治疗能够在不复发CMV视网膜炎的情况下完成以治愈为目标的淋巴瘤化疗。
