Cytomegalovirus Retinitis with Optic Neuritis in Non-Hodgkin's Lymphoma: Favorable Visual Outcome with Combined Antiviral Therapy

Abstract

Purpose: The study aims to describe the clinical presentation, diagnostic evaluation, treatment, and visual outcome of cytomegalovirus retinitis with optic neuritis and retinal vasculitis in a patient with non-Hodgkin’s lymphoma receiving chemotherapy. Case Presentation: A 54-year-old man with treated stage IV follicular non-Hodgkin’s lymphoma, who was receiving cycle 3 of ICE chemotherapy for recurrence, presented with sudden, painless visual loss in the left eye of two days’ duration. Best-corrected visual acuity was counting fingers at 2 metres, with a grade 3 relative afferent pupillary defect. Fundus examination showed optic disc oedema, extensive yellowish-white peripapillary retinitis with superficial haemorrhages, cystoid macular oedema, a subretinal haemorrhage, and perivascular sheathing suggestive of retinal vasculitis. Optical coherence tomography and fundus fluorescein angiography supported the clinical findings. Blood polymerase chain reaction was positive for cytomegalovirus, and vitreous qualitative polymerase chain reaction confirmed the diagnosis. Management and Outcome: The patient received combined antiviral treatment with repeated intravitreal ganciclovir and systemic valganciclovir. Following treatment, the retinitis regressed, the haemorrhages resolved, macular and optic disc oedema subsided, and visual acuity improved to 6/24. Central macular thickness decreased from 711 µm to 230 µm. Conclusion: This case demonstrates favourable anatomical and visual recovery following early molecular confirmation and prompt combined antiviral therapy in severe cytomegalovirus retinitis involving the optic nerve and retinal vasculature.