Recurrent Cytomegalovirus Retinitis in a Patient with Leukemia on Maintenance Chemotherapy

A 14-year-old boy, known case of acute lymphoblastic leukemia (ALL) on maintenance treatment presented with visual loss in lower half of visual field. Laboratory tests showed pancytopenia. ALL Relapse was ruled out by bone marrow aspiration. An ophthalmologic consultation was done and a diagnosis of “CMV retinitis” was made. CMV-PCR was positive with 3,000,000 copies/ml. CTscan of chest and abdomen was unremarkable and fungal infection assessments were negative. He was admitted and treatment with intravenous gancyclovir 10 mg/kg/ day along with intravitreal injection of gancyclovir was started for the patient. He received a course of 4-week treatment which was discontinued thereafter. Nine months later, he referred with fever and pancytopenia while on oral maintenance chemotherapy. Due to prolongation of fever and unexplained cytopenia, a thorough work-up was performed which yielded a plasma CMV-PCR of 3,500,000 copies/ml. Ophthalmologic examination established relapse of “retinitis” (figure 1). Another course of intravenous and intravitreal injection of gancyclovir initiated. He was assigned to receive a prolonged course of maintenance with oral valgancyclovir until attaining negative PCR in order to prevent CMV reactivation.