Topic outline

  • Grand Rounds

    A patient presented to the BPEI Clinic complaining of floaters in the right eye for ten weeks. Examination revealed a BCVA of 20/25 right eye and 20/20 left eye, mild keratic precipitates, +1 vitritis and a peripheral chorioretinal lesion on fundus exam in his right eye. Associated symptoms consisted on floaters. Past medical history was characteristic for Rheumatoid arthritis managed with Azathioprine, Methotrexate and Plaquenil. Anterior chamber paracentesis was made and sample was sent for PCR, treatment was started with intravitreal injection of Foscarnet 2.4 mg and Ganciclovir 2 mg, Oral treatment with Valacyclovir 2gr three times per day was started. Lab results came back positive for CMV, current treatment was stopped and Valganciclovir 900 BID as induction therapy for 21 days was started with good response. After 21 days treatment was switched to a maintenance therapy of 900 mg per day, interdisciplinary management led to a decrease in dose if his immunosuppressive therapy (azathioprine and methotrexate) and his chorioretinal lesion improved showing signs of remission.

    Presentation Date: 04/15/2021
    Issue Date: 04/23/2021