CMV retinitis in a stem cell transplant recipient treated with foscarnet intravitreal injection and CMV specific immunoglobulins.
CMV retinitis in a stem cell transplant recipient treated with foscarnet intravitreal injection and CMV specific immunoglobulins.
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DOI：
10.1177/2040620720975651
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发表时间：
2020
影响因子：
3.4
通讯作者：
Busca A
中科院分区：
文献类型：
--
作者：
Vassallo F;Nuzzi R;Cattani I;Dellacasa C;Giaccone L;De Rosa FG;Cavallo R;Iovino G;Brunello L;Bruno B;Busca A
摘要巨细胞病毒视网膜炎在异基因造血干细胞移植病人中并不常见。此外，对CMVR的眼科监测和充分的抗病毒治疗策略知之甚少。一例CMVR在异基因造血干细胞移植受体的描述，包括临床体征和治疗。一例成年患者接受了来自匹配的无关供体的HSCT治疗伯基特淋巴瘤。供体和受体均为CMV阳性。从第+40天开始，患者出现多次CMV再激活，接受缬更昔洛韦、膦甲酸和两者联合治疗。第+160天，患者开始主诉结膜充血和视力下降。眼底检查显示视网膜病变符合CMVR，尽管全血CMV DNA血症是阴性的。房水活检显示存在CMV感染（CMV DNA 230400 UI/ml）。CMVR组给予膦甲酸钠180 mg静脉注射和1.2 mg玻璃体内注射，联合抗CMV免疫球蛋白0.5 ml/kg，每2周1次。经过4周的全身治疗，20个每周剂量的玻璃体内膦甲酸和6个周期的免疫球蛋白，观察到视力的显着改善。治疗耐受性良好，无副作用。总之，我们的病例表明，全身和局部抗病毒治疗结合CMV特异性IVIG，可能会减少CMVR患者眼中的CMV负荷，导致视力的持续改善。对于多次CMV再激活和高峰CMV DNA水平高的HSCT受者，应推荐进行系统的眼科检查。
Cytomegalovirus (CMV) retinitis (CMVR) has been reported rarely in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). In addition, little is known about strategies for ophthalmic surveillance and adequate antiviral treatment of CMVR. A case of CMVR in an allogeneic HSCT recipient is described, including clinical signs and therapy. An adult patient received HSCT from a matched unrelated donor for treatment of a Burkitt lymphoma. Donor and recipients were both CMV positive. Starting on day +40, the patient presented multiple CMV reactivation, treated with valganciclovir, foscarnet and a combination of both. On day +160, the patient started complaining of conjunctival hyperaemia and a decrease in visual acuity. Fundoscopy revealed retinal lesions consistent with CMVR, although whole blood CMV DNAemia was negative. Aqueous humor biopsy showed the presence of CMV infection (CMV DNA 230400 UI/ml). CMVR was treated with foscarnet (180 mg i.v. and 1.2 mg intravitreal injection) combined with anti CMV immunoglobulin at 0.5 ml/kg every 2 weeks. After 4 weeks of systemic therapy, 20 weekly doses of intravitreal foscarnet and six cycles of immunoglobulins, a significant improvement of visual acuity was observed. The treatment was well tolerated with no side effect. In conclusion, our case suggests that systemic and local antiviral treatment combined with CMV-specific-IVIG, may reduce CMV load in the eye of patients with CMVR, leading to a consistent improvement of visual acuity. Systematic ophthalmologic examination should be recommended in HSCT recipients with multiple CMV reactivations and high peak CMV DNA levels.
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影响因子：
13.7
作者：
Jabs, Douglas A.;Ahuja, Alka;Yeh, Steven
通讯作者：
Yeh, Steven
影响因子：
2
作者：
Zhang Y;Ruan X;Yang W;Li L;Xian Z;Feng Q;Mo W
通讯作者：
Mo W
影响因子：
11.8
作者：
Crippa, F;Corey, L;Boeckh, M
通讯作者：
Boeckh, M
DOI：
10.1034/j.1399-3062.2002.01018.x
发表时间：
2002-06-01
期刊：
Transplant infectious disease : an official journal of the Transplantation Society
影响因子：
--
作者：
Larsson, Kajsa;Lonnqvist, B;Ljungman, P
通讯作者：
Ljungman, P
DOI：
10.1007/s00417-013-2368-6
发表时间：
2013-07-01
影响因子：
2.7
作者：
Miao, Heng;Tao, Yong;Li, Xiao-xin
通讯作者：
Li, Xiao-xin