title: Clinical manifestations of cytomegalovirus-associated posterior uveitis and panuveitis in patients without human immunodeficiency virus infection.
abstract: OBJECTIVE
  Little attention has been paid to clinical features of cytomegalovirus (CMV) infections in individuals without human immunodeficiency virus (HIV).
  
  
  OBJECTIVE
  To describe the clinical manifestations and comorbidities of patients without HIV infection who have CMV-associated posterior uveitis or panuveitis.
  
  
  METHODS
  Retrospective observational case series in an academic research setting.
  
  
  METHODS
  The medical records were reviewed of 18 patients (22 affected eyes) diagnosed as having posterior uveitis or panuveitis who had aqueous positive for CMV by polymerase chain reaction techniques.
  
  
  METHODS
  Demographic data, clinical manifestations, and associated systemic diseases were recorded.
  
  
  RESULTS
  Ocular features included focal hemorrhagic retinitis (n = 13) and peripheral retinal necrosis (n = 7). Two eyes had no focal retinal lesions but manifested vasculitis and vitritis. All patients exhibited vitreous inflammation. Inflammatory reactions in anterior segments developed in 14 of 22 eyes (64%). Retinal vasculitis was observed in 16 of 22 eyes (73%) and included mostly arteries (in 13 of 16 eyes [81%]). Eleven of 18 patients were taking immunosuppressive medications (5 for hematologic malignant diseases, 4 for systemic autoimmune diseases, and 2 following organ transplants). One additional patient was diagnosed as having non-Hodgkin lymphoma 3 months after the onset of CMV-associated panuveitis, and another patient had primary immunodeficiency disorder. Of the remaining 5 patients, 2 had diabetes mellitus, and 3 had no associated systemic diseases and exhibited no evidence of immune deficiency.
  
  
  CONCLUSIONS
  Cytomegalovirus-associated infections of posterior eye segments can develop in patients without HIV infection who have compromised immune function of variable severity but may occur also in individuals who have no evidence of immune insufficiency. Cytomegalovirus infections located in posterior eye segments in patients without HIV infection caused intraocular inflammatory reaction in all cases and demonstrated more variable clinical presentation than classic CMV retinitis observed in patients with HIV infection.
authors.affiliation: Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. kpathana@mail.med.cmu.ac.th
authors.forename: Kessara
authors.initials: K
authors.lastname: Pathanapitoon
authors.forename: Nattaporn
authors.initials: N
authors.lastname: Tesavibul
authors.forename: Pitipol
authors.initials: P
authors.lastname: Choopong
authors.forename: Sutasinee
authors.initials: S
authors.lastname: Boonsopon
authors.forename: Natedao
authors.initials: N
authors.lastname: Kongyai
authors.forename: Somsanguan
authors.initials: S
authors.lastname: Ausayakhun
authors.forename: Paradee
authors.initials: P
authors.lastname: Kunavisarut
authors.forename: Aniki
authors.initials: A
authors.lastname: Rothova
mesh_terms: D000328:Adult; D000368:Aged; D001082:Aqueous Humor / Q000821:virology; D018791:CD4 Lymphocyte Count; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D015828:Eye Infections, Viral / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015864:Panuveitis / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D015866:Uveitis, Posterior / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D014822:Vitreous Body / Q000473:pathology / Q000821:virology
chemical_list: D004279:DNA, Viral; D007166:Immunosuppressive Agents