CYTOMEGALOVIRUS RETINITIS IN NON-HIV IMMUNOCOMPROMISED INDIVIDUALS ON TOFACITINIB FOR RHEUMATOID ARTHRITIS.

PURPOSE: To describe two patients with long-standing rheumatoid arthritis who developed cytomegalovirus (CMV) retinitis while taking tofacitinib.

METHODS

Retrospective case series.

RESULTS

A 79-year-old woman with rheumatoid arthritis, treated with oral tofacitinib 11 mg once daily, presented with blurred vision and pain in the right eye. Visual acuity was hand motion, anterior segment showed iritis, and the intraocular pressure was 35 mmHg. Ophthalmoscopy revealed retinal hemorrhages and overlying vitreous hemorrhage. HIV serology showed negative results, serum CMV immunoglobulin G was positive, and aqueous polymerase chain reaction was positive for CMV (802,000 IU/mL). An 82-year-old woman with a history of rheumatoid arthritis, treated with tofacitinib 11 mg once daily, was referred for a white retinal lesion in the left eye. Visual acuity was 20/50, anterior segment was quiet, and intraocular pressure was 23 mmHg. Ophthalmoscopy revealed a yellow retinal lesion with ill-defined margins in the macula. She subsequently developed a new area of peripheral retinal whitening in the right eye. HIV serology showed negative results, serum CMV immunoglobulin G was positive, and aqueous polymerase chain reaction was positive for CMV (5,200,000 IU/mL).

CONCLUSION

Diagnosis of cytomegalovirus retinitis in non-HIV individuals requires awareness of the risk of infectious retinitis in patients taking Janus kinase inhibitors for the treatment of autoimmune disease.