Department of Ophthalmology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Virol J. 2013 Jan 7;10:18. doi: 10.1186/1743-422X-10-18.
To present a possible coincidence of cytomegalovirus retinitis and intraocular lymphoma in a patient with systemic non-Hodgkin's lymphoma.
A 47-year-old woman presented with decreased visual acuity associated with white retinal lesions in both eyes. A history of pneumonia of unknown aetiology closely preceded the deterioration of vision. Five years previously the patient was diagnosed with follicular non-Hodgkin's lymphoma. She was treated with a chemotherapy regimen comprised of cyclophosphamide, adriamycin, vincristin, and prednisone with later addition of the anti-CD20 antibody rituximab. She experienced a relapse 19 months later with involvement of the retroperitoneal lymph nodes, and commenced treatment with rituximab and 90Y-ibritumomab tiuxetan. A second relapse occurred 22 months after radioimmunotherapy and was treated with a combination of fludarabine, cyclophosphamide, and mitoxantrone followed by rituximab. The patient experienced no further relapses until the current presentation (April, 2010).Pars plana vitrectomy with vitreous fluid analysis was performed in the right eye. PCR testing confirmed the presence of cytomegalovirus in the vitreous. Atypical lymphoid elements, highly suspicious of malignancy were also found on cytologic examination. Intravenous foscarnet was administered continually for three weeks, followed by oral valganciclovir given in a dose of 900 mg twice per day. In addition, the rituximab therapy continued at three monthly intervals. Nevertheless, cessation of foscarnet therapy was followed by a recurrence of retinitis on three separate occasions during a 3-month period instigating its reinduction to the treatment regime after each recurrence.
Cytomegalovirus retinitis is an opportunistic infection found in AIDS patients as well as in bone marrow and solid organ transplant recipients being treated with systemic immunosuppressive drugs. This case presents a less common incidence of cytomegalovirus retinitis occurring in a patient with non-Hodgkin's lymphoma. We demonstrated a possible coexistence of cytomegalovirus retinitis and intraocular lymphoma in this particular patient. The final diagnosis was based on clinical manifestations together with the course of uveitis and its response to treatment alongside the results of vitreous fluid analysis. This report highlights the importance of intraocular fluid examination in cases with nonspecific clinical manifestations. Such an examination allows for the detection of simultaneously ongoing ocular diseases of differing aetiologies and enables the prompt initiation of effective treatment.
报告一例系统性非霍奇金淋巴瘤患者并发巨细胞病毒性视网膜炎和眼内淋巴瘤的可能巧合。
一名 47 岁女性，因双眼视力下降伴白色视网膜病变就诊。视力下降前，患者曾罹患不明病因肺炎。五年前，该患者被诊断为滤泡性非霍奇金淋巴瘤。她接受了环磷酰胺、阿霉素、长春新碱和泼尼松组成的化疗方案治疗，后加用抗 CD20 抗体利妥昔单抗。19 个月后疾病复发，累及腹膜后淋巴结，开始接受利妥昔单抗和 90Y-依替巴单抗替伊莫单抗治疗。放射免疫治疗后 22 个月再次复发，给予氟达拉滨、环磷酰胺和米托蒽醌联合利妥昔单抗治疗。直到本次就诊（2010 年 4 月）前，患者未再复发。右眼行玻璃体切割术联合玻璃体液分析。PCR 检测证实玻璃体内存在巨细胞病毒。细胞学检查还发现了高度可疑恶性的非典型淋巴样细胞。连续三周静脉用膦甲酸，随后口服缬更昔洛韦，每日两次，每次 900mg。此外，利妥昔单抗每三个月治疗一次。然而，停止膦甲酸治疗后，在 3 个月内，分别有 3 次出现视网膜炎复发，每次复发后都重新开始该治疗方案。
巨细胞病毒性视网膜炎是一种机会性感染，见于 AIDS 患者以及接受全身免疫抑制药物治疗的骨髓和实体器官移植受者。本病例报告了一例非霍奇金淋巴瘤患者中较少见的巨细胞病毒性视网膜炎。我们在该患者中发现了巨细胞病毒性视网膜炎和眼内淋巴瘤可能同时存在。最终诊断基于临床表现以及葡萄膜炎的病程和对治疗的反应，同时结合玻璃体液分析结果。本报告强调了在具有非特异性临床表现的病例中进行眼内液检查的重要性。这种检查可发现同时存在的不同病因的眼部疾病，并能及时开始有效的治疗。
