Successful treatment of cytomegalovirus retinitis in a patient with malignant lymphoma: a case report and review of the literature

A 52-year-old Japanese woman was diagnosed as having angioimmunoblastic T-c ell lymphoma (stage IV-B). She received 6 courses of chemotherapy including cyclophosphamide. doxorubicin, vincristine, and prednisolone every two wee ks (biweekly CHOP), and was considered to be in partial remission. She comp lained of loss of visual acuity in her right eye during her last cycle of c hemotherapy. Cytomegalovirus (CMV) retinitis was suspected from the charact eristic ophthalmoscopic appearance. This diagnosis was further supported by the detection of CMV DNA in blood and antigens in polymorphonuclear leukoc ytes, a sign of CMV reactivation. Although DNAemia and antigenemia became n egative, retinitis remained slightly active despite a 4-week systemic treat ment of ganciclovir. Intraocular injection of ganciclovir was started and c ontinued until the retinitis became inactive ophthalmoscopically. The patie nt received high-dose chemotherapy with peripheral blood stem cell transpla ntation and achieved complete remission. During and after this therapy no r ecurrence of CMV infections was observed. This case shows that 1) a quick a nd accurate diagnosis of CMV retinitis was possible by applying DNAemia and antigenemia and 2) intensive treatment for the CMV infection enabled the a ccomplishment of cure-oriented chemotherapy of the lymphoma without the rec urrence of CMV retinitis. (C) 1999 The Japanese Society of Hematology.