Patel Prem N, Alkaliby Ahmed M, Mehta Mitul C, Wang Angeline L
Department of Ophthalmology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9057, USA.
Gavin Herbert Eye Institute, UC Irvine, Irvine, CA, 92697, USA.
Allergy Asthma Clin Immunol. 2023 Aug 19;19(1):72. doi: 10.1186/s13223-023-00817-z.
The rate of cytomegalovirus (CMV) retinitis is increasing, likely secondary to aggressive immunosuppressive regimens for a variety of diseases. Transplant and rheumatological literature show growing evidence suggesting a unique relationship between CMV infection and mycophenolate in particular. This study reports two cases of CMV retinitis infection in patients on mycophenolate immunosuppression.
Case A was a 39-year-old African American woman with systemic lupus erythematosus (SLE) with stage IV lupus nephritis who presented for bilateral retinal detachments with areas of moth-eaten and thin retina concerning for prior viral retinitis. Case B was a 53-year-old man who presented with floaters in the right eye status-post heart transplant since 2008 on immunosuppressive therapy. Fundoscopic examination of the right eye showed frosted branch angiitis with intraretinal hemorrhage and inner retinal thickening and disorganization, consistent with CMV retinitis infection. Both patients were on mycophenolate immunosuppression with the recommendation to reduce or discontinue mycophenolate.
Patients on mycophenolate immunosuppression may be more vulnerable to cytomegalovirus infection, including CMV retinitis. Ophthalmologists should be aware of this increased risk and consider reducing or discontinuing mycophenolate to promote viral clearance in these susceptible patients, in conjunction with the patient's transplant or rheumatology teams.
巨细胞病毒（CMV）视网膜炎的发病率正在上升，这可能是多种疾病采用积极免疫抑制方案的继发结果。移植和风湿病学文献显示，越来越多的证据表明，CMV感染与霉酚酸酯之间存在独特的关系。本研究报告了两例接受霉酚酸酯免疫抑制治疗的患者发生CMV视网膜炎感染的病例。
病例A是一名39岁的非裔美国女性，患有系统性红斑狼疮（SLE），处于IV期狼疮性肾炎，因双侧视网膜脱离就诊，视网膜有虫蚀状和变薄区域，怀疑既往有病毒性视网膜炎。病例B是一名53岁男性，自2008年心脏移植后接受免疫抑制治疗，右眼出现飞蚊症。右眼眼底检查显示有霜样树枝状视网膜血管炎，伴有视网膜内出血和视网膜内层增厚及结构紊乱，符合CMV视网膜炎感染。两名患者均接受霉酚酸酯免疫抑制治疗，建议减少或停用霉酚酸酯。
接受霉酚酸酯免疫抑制治疗的患者可能更容易感染巨细胞病毒，包括CMV视网膜炎。眼科医生应意识到这种增加的风险，并考虑减少或停用霉酚酸酯，以便在这些易感患者中促进病毒清除，同时与患者的移植或风湿病团队协作。
