title: Opportunistic infections of the retina in patients with aquaporin-4 antibody disease.
abstract: OBJECTIVE
  Patients with neuromyelitis optica who have aquaporin-4 antibodies are being identified and receiving immunosuppressant treatment earlier and more aggressively as a result of increasing awareness of the importance of preventing relapses responsible for the high morbidity and mortality associated with the disease. To our knowledge, opportunistic retinal infection in patients with aquaporin-4 antibodies who are receiving immunosuppressants has not been reported to date.
  
  
  METHODS
  We describe 2 patients with aquaporin-4 antibodies who were receiving conventional doses of first-line immunosuppressive therapy. Both patients presented with vision loss that was initially thought to be optic neuritis attacks. The subsequent diagnoses were ocular toxoplasmosis and cytomegalovirus retinitis.
  
  
  CONCLUSIONS
  Retinal opportunistic infections can occur in patients with aquaporin-4 antibodies who are receiving relatively low levels of immunosuppression, may mimic optic neuritis, and are a potentially reversible cause of vision loss when treated promptly.
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, England.
authors.forename: Jithin S
authors.initials: JS
authors.lastname: George
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, England.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, England.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Kitley
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, England2Nuffield Department of Microbiology, University of Oxford, John Radcliffe Hospital, Oxford, England.
authors.forename: Nicola
authors.initials: N
authors.lastname: Jones
authors.affiliation: Department of Clinical Microbiology, Portsmouth Hospitals National Health Service Trust, Queen Alexandra Hospital, Cosham, Portsmouth, England.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cortes
authors.affiliation: Public Health England, Department of Virology, Bristol Public Health Laboratory, Bristol, England.
authors.forename: Matthew
authors.initials: M
authors.lastname: Donati
authors.affiliation: Department of Ophthalmology, The Royal Bournemouth and Christchurch Hospitals National Health Service Foundation Trust, Bournemouth, England.
authors.forename: Bethan Non
authors.initials: BN
authors.lastname: Matthews
authors.affiliation: Department of Ophthalmology, Worcestershire Acute Hospitals National Health Service Trust, Worcester, England.
authors.forename: Daniel
authors.initials: D
authors.lastname: Calladine
authors.affiliation: Department of Neurology, Poole Hospital, Poole, Dorset, England.
authors.forename: Charles
authors.initials: C
authors.lastname: Hillier
authors.affiliation: Department of Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, England.
authors.forename: Imran H
authors.initials: IH
authors.lastname: Yusuf
authors.affiliation: Department of Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, England.
authors.forename: Robert
authors.initials: R
authors.lastname: Munneke
authors.affiliation: Department of Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, England.
authors.forename: Chetan K
authors.initials: CK
authors.lastname: Patel
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, England.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Palace
authors.affiliation: Department of Ophthalmology, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, England.
authors.forename: John S
authors.initials: JS
authors.lastname: Elston
mesh_terms: D000368:Aged; D000906:Antibodies / Q000009:adverse effects / Q000627:therapeutic use; D051401:Aquaporin 4 / Q000276:immunology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D009894:Opportunistic Infections / Q000209:etiology* / Q000276:immunology; D009902:Optic Neuritis / Q000150:complications / Q000276:immunology*; D012160:Retina / Q000276:immunology*
chemical_list: D000906:Antibodies; D051401:Aquaporin 4; D007166:Immunosuppressive Agents