Hypertensive iridocyclitis associated with delayed onset biopsy proven Cytomegalovirus retinitis.

Abstract

We describe a case of primary hypertensive iridocyclitis with biopsy-proven Cytomegaloviral retinitis. It is an observational case report of a 69-year-old diabetic gentleman on azathioprine for Crohn's disease who presented with recurrent episodes of hypertensive iridocyclitis. On the 4 th attendance in 5 months, a granular white lesion was noted in the temporal periphery of the mid-peripheral fundus and a chorioretinal and vitreous biopsy performed. Vitreous PCR was positive for Cytomegalovirus (CMV). Hematoxylin and eosin staining revealed cytomegalic-like inclusions within necrotic neural retina. Transmission electron microscopy revealed herpes family virus particles and immunohistochemistry demonstrated CMV protein. This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. With hindsight, the cumulative effect of diabetes and azathioprine on the immune surveillance system proved sufficient to render the patient susceptible to CMV retinitis.

• Authors: David M Squirrell, Sudipto Bhatta, Hardeep S Mudhar, Ian G Rennie
• Journal: Indian journal of ophthalmology (Indian J Ophthalmol) Vol. 62 Issue 5 Pg. 656-8 (May 2014) ISSN: 1998-3689 [Electronic] India
• PMID: 23548320 (Publication Type: Case Reports, Journal Article)

Chemical References

• DNA, Viral

Topics

• Aged
• Biopsy
• Cytomegalovirus (genetics)
• Cytomegalovirus Infections (complications, diagnosis, virology)
• Cytomegalovirus Retinitis (complications, diagnosis, virology)
• DNA, Viral (analysis)
• Diagnosis, Differential
• Eye Infections, Viral (complications, diagnosis, virology)
• Humans
• Iridocyclitis (diagnosis, etiology)
• Male
• Polymerase Chain Reaction