Baxter Julia, Kailasanathan Anusha, Chen Hean
Department of Ophthalmology, Royal Derby Hospital, Derby, Derbyshire, UK.
BMJ Case Rep. 2011 Feb 14;2011:bcr0820103235. doi: 10.1136/bcr.08.2010.3235.
A 51-year-old male on chemotherapy for myeloma presented initially with a unilateral optic disc haemorrhage and signs of optic neuropathy. This rapidly progressed to affect both eyes and within a few days he developed retinal features suggestive of progressive outer retinal necrosis. He was treated with intravenous acyclovir that was subsequently changed to ganciclovir when serological tests for cytomegalovirus were found to be positive for immunoglobulin M antibodies. His visual loss continued to deteriorate despite treatment, and he subsequently developed a retinal detachment in one eye. The causes of optic neuropathy in immunocompromised patients and the importance of eliminating an infective cause are discussed.
一名51岁接受骨髓瘤化疗的男性最初出现单侧视盘出血和视神经病变体征。病情迅速进展至双眼，数天内出现提示进行性外层视网膜坏死的视网膜特征。给予静脉注射阿昔洛韦治疗，随后在巨细胞病毒血清学检测发现免疫球蛋白M抗体呈阳性时改为更昔洛韦治疗。尽管进行了治疗，他的视力仍持续恶化，随后一只眼睛发生了视网膜脱离。本文讨论了免疫功能低下患者视神经病变的病因以及消除感染性病因的重要性。
