ABSTRACT
A 49-year-old man with AIDS developed acute monocular visual loss and an ipsilateral swollen optic disc with a large right relative afferent pupillary defect, a nerve fiber bundle visual field defect, and a peripapillary retinal infiltrate. Lumbar puncture disclosed cytomegalovirus (CMV) DNA on polymerase chain reaction (PCR). Treatment with oral valganciclovir produced complete resolution of the visual deficits and the fundus abnormality. This case differs from previously reported cases of CMV optic neuritis in which visual function has been irreversibly lost.
Subject(s)
Cytomegalovirus Retinitis/physiopathology , Optic Neuritis/physiopathology , Optic Neuritis/virology , Retina/physiopathology , Retina/virology , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/physiopathology , AIDS-Related Opportunistic Infections/virology , Antiviral Agents/therapeutic use , Cytomegalovirus Retinitis/pathology , DNA, Viral/analysis , DNA, Viral/cerebrospinal fluid , Ganciclovir/therapeutic use , Humans , Male , Middle Aged , Optic Disk/pathology , Optic Disk/physiopathology , Optic Disk/virology , Optic Nerve/pathology , Optic Nerve/physiopathology , Optic Nerve/virology , Optic Neuritis/pathology , Papilledema/pathology , Papilledema/physiopathology , Papilledema/virology , Retina/pathology , Treatment Outcome , Vision, Low/pathology , Vision, Low/physiopathology , Vision, Low/virologyABSTRACT
A 22-year-old immunocompetent woman who presented with a 3-week history of fever, headache, and visual loss and was found to have subnormal visual acuity and bilateral optic disc swelling. Serum cytomegalovirus (CMV) IgM and IgG and polymerase chain reaction results were positive, indicating an acute CMV infection. No cause of immunocompromise was found. After treatment with intravenous ganciclovir, the papillitis and systemic CMV illness resolved with no residual deficit. This is the first reported case of primary CMV papillitis to be successfully treated with ganciclovir alone.
