Retinal cases & brief reports · 2026
Cytomegalovirus-associated Panretinal Occlusive Vasculopathy without Retinal Necrosis as the Heralding Feature of Good Syndrome.
СтатьяНазвание и аннотация: Перевод в очереди
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Rajesh Anand E, Grassmeyer Justin J, Wilson Reid L, Jiang Angela, Murphy Melissa, Sabella Colleen, Faridi Ambar, Suhler Eric B
Аннотация
PURPOSE: To introduce an atypical occlusive panretinal vasculitis without necrotizing retinitis secondary to cytomegalovirus (CMV) infection as the heralding clinical event for a patient ultimately discovered to have Good Syndrome, a systemic immunodeficiency.
METHODS: Case report.
RESULTS: A 77-year-old male with a history of hypertension, diabetes mellitus, recurrent sinusitis, and oral thrush presented with 3 weeks of headaches and vision loss (20/250) in the right eye. Examination revealed panuveitis, scattered mid-peripheral intraretinal hemorrhages without retinal necrosis, profound retinal vascular nonperfusion, and elevated IOP due to anterior segment neovascularization. Aqueous humor viral PCR analysis revealed a high CMV viral load. Systemic evaluation was negative for HIV, CMV, toxoplasmosis, and syphilis; carotid duplex imaging was normal, leukemia and lymphoma studies were negative; and he was not neutropenic. CD4+ count and immunoglobulin levels were decreased, suggesting a combined B- and T-cell immunodeficiency. Computed tomography of the chest revealed a thymoma, consistent with Good Syndrome, a rare immunocompromising condition. Antiviral therapy did not significantly reverse retinal perfusion.
CONCLUSION: Panretinal occlusive vasculitis without retinal necrosis is a rare phenotype of CMV retinitis. In HIV-negative patients with CMV retinitis, additional immunodeficiency workup is required, and rare combined immunodeficiencies such as Good Syndrome should be included on the differential.
METHODS: Case report.
RESULTS: A 77-year-old male with a history of hypertension, diabetes mellitus, recurrent sinusitis, and oral thrush presented with 3 weeks of headaches and vision loss (20/250) in the right eye. Examination revealed panuveitis, scattered mid-peripheral intraretinal hemorrhages without retinal necrosis, profound retinal vascular nonperfusion, and elevated IOP due to anterior segment neovascularization. Aqueous humor viral PCR analysis revealed a high CMV viral load. Systemic evaluation was negative for HIV, CMV, toxoplasmosis, and syphilis; carotid duplex imaging was normal, leukemia and lymphoma studies were negative; and he was not neutropenic. CD4+ count and immunoglobulin levels were decreased, suggesting a combined B- and T-cell immunodeficiency. Computed tomography of the chest revealed a thymoma, consistent with Good Syndrome, a rare immunocompromising condition. Antiviral therapy did not significantly reverse retinal perfusion.
CONCLUSION: Panretinal occlusive vasculitis without retinal necrosis is a rare phenotype of CMV retinitis. In HIV-negative patients with CMV retinitis, additional immunodeficiency workup is required, and rare combined immunodeficiencies such as Good Syndrome should be included on the differential.