Hypertensive iridocyclitis associated with delayed onset biopsy proven Cytomegalovirus retinitis

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 atte...

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Bibliographic Details
Published in:Indian journal of ophthalmology 2014-05, Vol.62 (5), p.656-658
Main Authors: Squirrell, David M, Bhatta, Sudipto, Mudhar, Hardeep S, Rennie, Ian G
Format: Article
Language:English
Subjects:
Aged
Biopsy
Brief Communications
Care and treatment
Case studies
Cytomegalovirus
Cytomegalovirus - genetics
Cytomegalovirus infections
Cytomegalovirus Infections - complications
Cytomegalovirus Infections - diagnosis
Cytomegalovirus Infections - virology
Cytomegalovirus Retinitis - complications
Cytomegalovirus Retinitis - diagnosis
Cytomegalovirus Retinitis - virology
Diagnosis
Diagnosis, Differential
DNA, Viral - analysis
Eye Infections, Viral - complications
Eye Infections, Viral - diagnosis
Eye Infections, Viral - virology
Humans
Iridocyclitis - diagnosis
Iridocyclitis - etiology
Male
Physiological aspects
Polymerase Chain Reaction
Retinal diseases
Uveitis
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Summary: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.
ISSN:0301-4738
1998-3689
DOI:10.4103/0301-4738.97086