Cytomegalovirus infection with MRI signal abnormalities affecting the optic nerves, optic chiasm, and optic tracts.
A 49-year-old woman who had been immunosuppressed after a renal transplant developed bilateral severe visual loss. Visual acuities were finger counting and hand movements in the two eyes. Both optic nerves were pale. There were no other ophthalmic abnormalities. Brain MRI disclosed marked signal abnormalities involving the optic nerves, optic chiasm, and optic tracts. Cerebrospinal fluid polymerase chain reaction (PCR) was positive for cytomegalovirus. Treatment did not restore vision. Such extensive clinical and imaging involvement of the anterior visual pathway, which has been previously reported with other herpes viruses, illustrates the propensity for this family of viruses to track along axons.
Pershing
Suzann
S
Department of Ophthalmology, Stanford University School of Medicine, University Medical Center, 900 Blake-Wilbur Drive, Stanford, CA 94305-5353, USA.
Dunn
Jeffrey
J
Khan
Ahmir
A
Liao
Yaping Joyce
YJ
D000998:Antiviral Agents; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009897:Optic Chiasm / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D009900:Optic Nerve / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D020335:Paraparesis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000821:virology; D049268:Positron-Emission Tomography; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000821:virology; D017211:Treatment Failure; D014786:Vision Disorders / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*; D015354:Vision, Low / Q000473:pathology / Q000503:physiopathology / Q000821:virology; D014795:Visual Pathways / Q000473:pathology* / Q000503:physiopathology / Q000821:virology*
D000998:Antiviral Agents; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D015774:Ganciclovir