Open AccessHypertensive iridocyclitis associated with delayed onset biopsy proven Cytomegalovirus retinitis
Author(s) -
David Squirrell,
Sudipto Bhatta,
Hardeep Singh Mudhar,
I G Rennie
Publication year - 2014
Publication title -
indian journal of ophthalmology/indian journal of ophthalmology
Language(s) - Uncategorized
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 51
eISSN - 1998-3689
pISSN - 0301-4738
DOI - 10.4103/0301-4738.97086
Subject(s) - medicine , retinitis , cytomegalovirus , cytomegalovirus retinitis , azathioprine , biopsy , pathology , fundus (uterus) , lesion , ophthalmology , human cytomegalovirus , immunology , virus , viral disease , herpesviridae , disease
We describe a case of primary hypertensive iridocyclitis with biopsy-proven Cytomegaloviral retinitis. It is an observational case report of a 69-year-old diabetic gentleman on azathioprine for Crohn's disease who presented with recurrent episodes of hypertensive iridocyclitis. On the 4 th attendance in 5 months, a granular white lesion was noted in the temporal periphery of the mid-peripheral fundus and a chorioretinal and vitreous biopsy performed. Vitreous PCR was positive for Cytomegalovirus (CMV). Hematoxylin and eosin staining revealed cytomegalic-like inclusions within necrotic neural retina. Transmission electron microscopy revealed herpes family virus particles and immunohistochemistry demonstrated CMV protein. This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. With hindsight, the cumulative effect of diabetes and azathioprine on the immune surveillance system proved sufficient to render the patient susceptible to CMV retinitis.