ABSTRACT
Background: Cytomegalovirus (CMV) retinitis is an uncommon
presentation post allogeneic transplant and can be vision-threatening.
Our case demonstrates the occurrence of polymerase chain reaction proven
mixed viral retinitis (cytomegalovirus and varicella zoster virus) post
allogeneic stem cell transplant despite multiple prophylactic antiviral
therapies, and features CMV retinitis in the absence of CMV DNAemia.
This case highlights the emerging challenge of late CMV disease
occurring during secondary prophylaxis with Letermovir.
Case presentation: A 21-year-old female with acute myeloid
leukemia presented with mixed viral retinitis (cytomegalovirus and
varicella zoster virus) post allogenic transplant. This presentation
occurred despite ongoing prophylaxis for both of these viruses, as well
as following two courses of treatment for CMV viremia, with a documented
negative CMV PCR in the blood prior to the presentation with retinitis.
The patient was treated with intravenous Ganciclovir and subsequently
transitioned to oral Valganciclovir with resolution of the retinitis.
Conclusions: We report a rare case of polyviral retinitis in a
post-allogeneic stem cell transplant patient, with polymerase chain
reaction of the aqueous fluid demonstrating two viral populations. With
very little existing literature on either mixed viral retinitis or CMV
retinitis during Letermovir prophylaxis, this case expands the
literature on both topics.