Grand Rounds
A patient with no past ocular history presented with right eye pain, redness, photophobia, decreased vision for a week. His exam was notable for visual acuity 20/50 in the right eye and 20/20 in the left eye. Intra-ocular pressure was 20 and 17 mmHg. The slit-lamp exam was notable for active corneal precipitates, anterior chamber reaction 1+ cell with flare. There were no iris nodules/synechiae. Posterior segment exam with vitreous haze. Funduscopic exam notable for slight optic disc edema, vascular sheathing, and diffuse creamy lesions with large creamy lesion temporal to the fovea. Laboratory studies performed and anterior vitreous tap culture collected and tested by polymerase chain reaction analysis showed positivity for CMV and VZV. The lesion improved clinically rapidly after Valacyclovir was stopped and Valganciclovir initiated. According to the clinical response to Valganciclovir and clinical exam findings, CMV likely was the cause of retinitis in this case. The patient is currently continuing a prophylactic dose of Valganciclovir, his vision improved to 20/40 without active inflammation on the exam.
Presentation Date: 12/16/2021
Issue Date: 01/07/2022
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