Ware Matthaeus, Motekalem Yasmin, Zaslavsky Kirill, Cruz-Pimentel Miguel, Kukreti Vishal, Kaplan Alexander J, Yan Peng
Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Ocul Immunol Inflamm. 2025 May;33(4):701-704. doi: 10.1080/09273948.2024.2432554. Epub 2024 Nov 25.
To report a case of cytomegalovirus (CMV)-related hemorrhagic retinal vasculitis in a patient with multiple myeloma (MM) on daratumumab, a trial cereblon E3 ligase modulatory drug (CELMoD), dexamethasone, and acyclovir, and discuss clinical implications for CMV prophylaxis.
Case report, narrative review of CMV reactivation risk in MM patients on daratumumab and antiviral agent efficacy for CMV prophylaxis.
A 63-year-old female presented with 3 days of progressive unilateral vision loss in the right eye to the level of counting fingers. She had a history of relapsed and refractory MM and autologous stem cell transplant (ASCT). At the time of presentation, she was receiving daratumumab, a trial CELMoD, dexamethasone, and acyclovir. Posterior segment exam demonstrated trace vitreous cells (0.5+ vitritis as per SUN criteria) and scattered hemorrhages with multifocal intraluminal vascular whitening, aligned with infectious posterior uveitis and suggestive of panretinal occlusive vasculitis. Optical coherence tomography showed inner macular edema and epiretinal membrane formation. CMV reactivation was confirmed with PCR of anterior chamber fluid and blood.
Patients with MM on daratumumab are at increased risk of opportunistic reactivations including CMV, potentially due to daratumumab's immunomodulatory side effects. Our patient developed CMV-related hemorrhagic retinal vasculitis despite low-dose acyclovir, which provides limited protection against CMV reactivation in CMV seropositive individuals. This case report therefore offers casuistic support for ophthalmic screening for CMV reactivation or CMV prophylaxis with letermovir in this patient population.
报告1例在接受达雷妥尤单抗、一种试验性大脑E3连接酶调节剂（CELMoD）、地塞米松和阿昔洛韦治疗的多发性骨髓瘤（MM）患者中发生的与巨细胞病毒（CMV）相关的出血性视网膜血管炎病例，并讨论CMV预防的临床意义。
病例报告，对接受达雷妥尤单抗治疗的MM患者中CMV再激活风险及抗病毒药物预防CMV疗效的叙述性综述。
一名63岁女性出现右眼进行性单眼视力丧失3天，降至仅能数指的水平。她有复发难治性MM和自体干细胞移植（ASCT）病史。就诊时，她正在接受达雷妥尤单抗、一种试验性CELMoD、地塞米松和阿昔洛韦治疗。后段检查显示微量玻璃体细胞（根据SUN标准为0.5 + 玻璃体炎）和散在出血，伴有多灶性管腔内血管变白，符合感染性后葡萄膜炎，提示全视网膜闭塞性血管炎。光学相干断层扫描显示黄斑内层水肿和视网膜前膜形成。通过前房液和血液的PCR证实了CMV再激活。
接受达雷妥尤单抗治疗的MM患者发生包括CMV在内的机会性再激活的风险增加，这可能归因于达雷妥尤单抗的免疫调节副作用。尽管使用了低剂量阿昔洛韦，我们的患者仍发生了与CMV相关的出血性视网膜血管炎，阿昔洛韦对CMV血清阳性个体的CMV再激活提供的保护有限。因此，本病例报告为该患者群体中进行CMV再激活的眼科筛查或使用来特莫韦进行CMV预防提供了病例支持。
