Tugal-Tutkun Ilknur, Araz Bilge, Cagatay Atahan
Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul Tip Fakultesi, Goz Hastaliklari A.D, Capa, 34390, Istanbul, Turkey.
Int Ophthalmol. 2010 Oct;30(5):591-3. doi: 10.1007/s10792-009-9332-9. Epub 2009 Dec 24.
We report the case of a patient with Behçet's uveitis who developed cytomegalovirus (CMV) retinitis after intravitreal triamcinolone acetonide (IVTA) injection. We reviewed the patient's chart for the purpose of this report. An IVTA injection was performed for treatment of severe panuveitis in the left eye of a 30-year-old male patient with Behçet's disease. Systemic treatment included high dose corticosteroid and azathioprine. Fourteen weeks after IVTA, extensive areas of necrotizing retinitis developed in the left eye. Polymerase chain reaction of serum and vitreous samples was positive for CMV DNA. Serum anti-CMV IgG was positive, IgM was negative, anti-HIV antibody was negative, complete blood count was normal, and CD4 count was 1,060 cells/μl. The patient responded well to intravitreal ganciclovir injection performed twice and intravenous ganciclovir treatment administered for five weeks. Local immunosuppression with IVTA may cause CMV retinitis. Awareness of this serious complication is important for correct diagnosis and treatment.
我们报告了1例白塞氏葡萄膜炎患者，在玻璃体内注射曲安奈德（IVTA）后发生巨细胞病毒（CMV）视网膜炎。为撰写本报告，我们查阅了该患者的病历。对一名30岁患有白塞氏病的男性患者的左眼进行IVTA注射，以治疗严重的全葡萄膜炎。全身治疗包括大剂量皮质类固醇和硫唑嘌呤。IVTA注射14周后，左眼出现广泛的坏死性视网膜炎区域。血清和玻璃体样本的聚合酶链反应显示CMV DNA呈阳性。血清抗CMV IgG呈阳性，IgM呈阴性，抗HIV抗体呈阴性，全血细胞计数正常，CD4计数为1060个细胞/μl。该患者对两次玻璃体内注射更昔洛韦及为期五周的静脉注射更昔洛韦治疗反应良好。IVTA导致的局部免疫抑制可能会引发CMV视网膜炎。认识到这种严重并发症对于正确诊断和治疗很重要。
