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Acute necrotizing retinitis in a patient receiving immunosuppressive therapy.

1972; BMJ; Volume: 56; Issue: 7 Linguagem: Inglês

10.1136/bjo.56.7.555

1468-2079

Ruth Porter,

Cytomegalovirus and herpesvirus research

Patients with impaired immunological defence mechanisms due to malignant invasive conditions such as the leukaemias and their associated cytotoxic drug therapy, or to the administration of immunosuppressive drugs, are particularly prone to infection with organisms usually thought of as benign under normal conditions.In particular the inci- dence of cytomegalic inclusion disease is increasing both in children (Cangir and Sullivan, I966) and adults (Wong and Warner, I962; Smith, I964; Hedley-Whyte and Craighead, I965) under these conditions, and in a very small minority of these patients ocular involve- ment has been reported (Burns, 1959; Dvorak-Theobald, 1959; Smith, I964; Ashton and Cunha-Vaz, I966; Wallow, I969; de Venecia, Zu Rhein, Pratt, and Kisken, 197I).This is a report of a patient who developed a bilateral necrotizing retinitis while receiving immunosuppressive therapy after a renal transplant operation. Case reportA 27-year-man was first seen in March, 1970, as part of an ocular survey of patients with renal transplants.A year previously he had received a transplanted kidney from his brother after his own renal failure.The immediate postoperative period had been stormy, and of possible significance at that time was an attack of acute parotitis which had resolved with antibiotic therapy.The postoperative rejection phenomenon had continued to prove difficult to control and cyclophosphamide had been added to the more usual immunosuppressive therapy of prednisone and azathioprine.This regime had had to be continued in order to maintain a reasonable renal function and when he was seen in the ophthalmic department one year later he was still receiving azathioprine 150 mg. per day, prednisone 50 mg.four times a day, and cyclophosphamide 30 mg. per day.He complained of reduced vision in the right eye dating from the time of uncontrolled hypertension 2 years pre- viously.