Cytomegalovirus retinitis after intravitreous triamcinolone in an immunocompetent patient.
OBJECTIVE
To report the case of a 75-year-old man with diabetes who developed cytomegalovirus (CMV) retinitis after intravitreous injection of triamcinolone acetonide (IVTA).


METHODS
Observational case report.


METHODS
Review of medical records.


RESULTS
A 75-year-old man with diabetic macular edema developed arcuate retinal whitening after IVTA. A presumptive diagnosis of viral retinitis was made, and a vitrectomy was performed. Polymerase chain reaction of the vitreous was positive for CMV DNA. An infectious disease consultant found no signs of systemic CMV infection, and laboratory examination revealed that the patient was HIV negative. The patient responded well to intravitreal ganciclovir and oral valganciclovir, but when therapy was discontinued, the retinitis recurred and CMV DNA was again detected in the vitreous. The retinitis once again responded to antiviral therapy.


CONCLUSIONS
CMV retinitis can occur after local immunosuppression with IVTA. Clinicians should be aware of this rare complication of IVTA.
Saidel
Michael A
MA
Francis I. Proctor Foundation, University of California at San Francisco, 95 Kirkham Street, San Francisco, CA 94143, USA. msaidel@yahoo.com
Berreen
John
J
Margolis
Todd P
TP
D000368:Aged; D003587:Cytomegalovirus / Q000235:genetics; D017726:Cytomegalovirus Retinitis / Q000139:chemically induced*; D004279:DNA, Viral / Q000032:analysis; D003930:Diabetic Retinopathy / Q000276:immunology; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007267:Injections; D008269:Macular Edema / Q000276:immunology; D008297:Male; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D000077562:Valganciclovir; D014822:Vitreous Body / Q000821:virology
D004279:DNA, Viral; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D000077562:Valganciclovir; D015774:Ganciclovir