Cytomegalovirus (CMV)
retinitis with idiopathic CD4(+)
T lymphocytopenia (ICL) is rare and difficult to control. We report a first case for long-term control of CMV
retinitis with ICL using
interleukin-2 (IL-2)
therapy and succeeded in discontinuation of anti-CMV
therapy. A 49-year-old Japanese woman was diagnosed with ICL based on low CD4(+) count (72/μl), negative for HIV-1 and -2
antibodies, and absence of any defined immunodeficiency diseases or immunosuppressive therapy. PCR test of the aqueous humor in the right eye was suggestive of CMV
retinitis. She was treated with systemic
ganciclovir, but after several relapses of CMV
retinitis, rhegmatogenous
retinal detachment appeared in the right eye and she became blind in that eye. Three years later, she developed CMV
retinitis in the left eye. Although she received systemic and focal anti-CMV treatments, the
retinitis showed no improvement. Finally,
retinal detachment occurred, and she underwent
vitrectomy.
IL-2 was injected to increase CD4(+) counts. Because of
hyperpyrexia, blepharedema,
central scotoma, and color anomaly, we changed to low-dose
IL-2 therapy with no side effects. Finally, we succeeded in increasing the CD4(+) count to more than 200/μl after discontinuation of low-dose
IL-2 therapy. CMV
retinitis never recurred after discontinuation of anti-CMV
therapy, with good visual acuity of 20/20 in the left eye. She developed
blindness of the first affected right eye, whereas the visual acuity of the left eye remains excellent more than 12 years after the onset of CMV
retinitis through the combined use of anti-CMV
therapy,
IL-2 therapy, and
vitrectomy.