Elsevier

Mayo Clinic Proceedings

Volume 78, Issue 11, November 2003, Pages 1412-1415
Mayo Clinic Proceedings

Case Report
Bilateral Cytomegalovirus Retinitis in a Patient With Systemic Lupus Erythematosus and End-Stage Renal Disease

https://doi.org/10.4065/78.11.1412Get rights and content

Rheumatic diseases are not commonly associated with cytomegalovirus (CMV) retinitis. We report a case of bilateral CMV retinitis in a human immunodeficiency virus- seronegative patient with systemic lupus erythematosus (SLE) who was undergoing hemodialysis for end-stage renal disease. The CMV retinitis in this patient was associated with combined azathioprine and low-dose corticosteroid therapy for lupus flare. This association may have important clinical implications because this drug combination is used routinely to treat active SLE. Our patient responded to discontinuation of azathioprine, reduction of the corticosteroid dose, and systemic administration of ganciclovir. We recommend that clinicians maintain heightened awareness of the possibility of CMV retinitis in patients with SLE and end-stage renal disease who are receiving azathioprine and low-dose corticosteroids.

Section snippets

Report of A Case

In May 2000, a 37-year-old woman was seen in our eye clinic for evaluation of floaters noted in her right eye for the preceding 2 weeks. She had no other symptoms, and a review of systems yielded normal findings. Her history was remarkable for SLE diagnosed 17 years previously in Jamaica. In 1993, a renal biopsy performed at another US hospital revealed diffuse proliferative glomerulonephritis. The patient received 10 cycles of intravenous bolus cyclophosphamide and was lost to medical

Discussion

Smith7 first described CMV retinitis in 1964 as an opportunistic infection of the neural retina that occurs in patients whose immune system is suppressed. Cytomegalovirus retinitis has been reported in patients receiving immunosuppressive medications after renal or heart transplantation, in patients who are immunocompromised due to leukemia and lymphoma, and in patients with acquired immunodeficiency syndrome.1, 2, 3, 4 To our knowledge, an association between SLE and CMV retinitis in the

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    Notably, CMV infection can be considered as an opportunistic infection, when affecting SLE patients on chronic steroids and/or immunosuppressive agents. Among the possible CMV-related manifestations, retinitis has to be kept in mind, especially when ongoing therapy includes both azathioprine and low-dose corticosteroid [43]. Interestingly, SLE has a lower incidence in the human immunodeficiency virus (HIV)-infected population when compared to the general population [44].

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1

Dr Choksi is now with Winthrop University Hospital, Mineola, NY.

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