Centro Hospitalar do Porto, Departamento de Nefrologia e Transplante Renal, Porto, Portugal.
Universidade Federal de São Paulo, Hospital do Rim, Departamento de Nefrologia, São Paulo, SP, Brasil.
J Bras Nefrol. 2022 Jul-Sep;44(3):457-461. doi: 10.1590/2175-8239-JBN-2020-0254.
Cytomegalovirus (CMV) retinitis is a rare manifestation of CMV invasive disease and potentially threatening to vision in immunocompromised individuals. Clinical suspicion is fundamental since it is an unusual entity with a progressive and often asymptomatic installation over a long period. The authors report a 70-year-old man with diabetic nephropathy who underwent a kidney transplant (KT) in August 2014 with good clinical evolution. No previous CMV infection or episodes of acute rejection were reported. Five years after transplant, he was admitted due to a reduced visual acuity of the left eye with seven days of evolution with associated hyperemia, without exudate. The ophthalmologic evaluation was compatible with acute necrosis of the retina and presumed associated with CMV infection. He had a progressive improvement after ganciclovir initiation. CMV retinitis is one of the most serious ocular complications in immune-suppressed individuals and can lead to irreversible blindness, and because of that, early diagnosis and treatment remains crucial in obtaining the best visual prognosis in affected patients. Secondary prophylaxis with ganciclovir is not consensual, neither is the safety of reintroducing the antimetabolite in these cases.
巨细胞病毒（CMV）视网膜炎是 CMV 侵袭性疾病的罕见表现，对免疫功能低下者的视力有潜在威胁。临床怀疑是基本的，因为它是一种不常见的实体，具有渐进性，并且通常在很长一段时间内无症状安装。作者报告了一名 70 岁男性，患有糖尿病肾病，于 2014 年 8 月接受了肾移植（KT），临床结果良好。没有报告先前的 CMV 感染或急性排斥反应发作。移植后五年，他因左眼视力下降七天入院，伴有充血，无渗出。眼科评估与视网膜急性坏死相符，推测与 CMV 感染有关。他在开始使用更昔洛韦后逐渐改善。CMV 视网膜炎是免疫抑制个体中最严重的眼部并发症之一，可导致不可逆转的失明，因此，早期诊断和治疗对于获得受影响患者的最佳视觉预后仍然至关重要。用更昔洛韦进行二级预防并不一致，在这些情况下重新引入抗代谢物也不安全。
