ABSTRACT
A 49-year-old woman who had been immunosuppressed after a renal transplant developed bilateral severe visual loss. Visual acuities were finger counting and hand movements in the two eyes. Both optic nerves were pale. There were no other ophthalmic abnormalities. Brain MRI disclosed marked signal abnormalities involving the optic nerves, optic chiasm, and optic tracts. Cerebrospinal fluid polymerase chain reaction (PCR) was positive for cytomegalovirus. Treatment did not restore vision. Such extensive clinical and imaging involvement of the anterior visual pathway, which has been previously reported with other herpes viruses, illustrates the propensity for this family of viruses to track along axons.
Subject(s)
Cytomegalovirus Infections/complications , Vision Disorders/pathology , Vision Disorders/virology , Visual Pathways/pathology , Visual Pathways/virology , Antiviral Agents , Cytomegalovirus/genetics , Cytomegalovirus Infections/immunology , Cytomegalovirus Infections/physiopathology , DNA, Viral/analysis , Female , Ganciclovir/therapeutic use , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Kidney Transplantation , Magnetic Resonance Imaging , Middle Aged , Optic Chiasm/pathology , Optic Chiasm/physiopathology , Optic Chiasm/virology , Optic Nerve/pathology , Optic Nerve/physiopathology , Optic Nerve/virology , Paraparesis/diagnostic imaging , Paraparesis/physiopathology , Paraparesis/virology , Positron-Emission Tomography , Spinal Cord/diagnostic imaging , Spinal Cord/physiopathology , Spinal Cord/virology , Treatment Failure , Vision Disorders/physiopathology , Vision, Low/pathology , Vision, Low/physiopathology , Vision, Low/virology , Visual Pathways/physiopathologyABSTRACT
Immunocompromised patients are known to be at risk for varicella-zoster virus reactivation, often in atypical manners. We describe a 30-year-old man with simultaneous involvement of the retina, optic chiasm, and optic nerve with varicella-zoster virus who had a bitemporal visual field defect.
