Should active CMV retinitis in non-immunocompromised newborn babies be treated?
- Department of Ophthalmology, King's College Hospital, Denmark Hill , London SE5 9RS, UK
- Correspondence to: W Aclimandos; fayebart{at}hotmail.com
- Accepted 15 August 2001
Cytomegalovirus (CMV) retinitis in children with congenital CMV infection is known to differ from that described in immunocompromised subjects, because it is present at birth and does not progress postnatally if the child is otherwise immunocompetent. Regarding treatment, there are limited data in infants with symptomatic congenital CMV infection and it is not known whether antiviral drugs alter the prognosis. We describe a case of congenital CMV retinitis that progressed postnatally and our treatment regimen.
Case report
A 9 day old baby was referred to the eye clinic after having been diagnosed with congenital symptomatic CMV infection.
During pregnancy, at 34 weeks, poor growth and ventriculomegaly were noted and a scan at 35 weeks showed bilateral cysts in the occipital horn of the lateral ventricles. He was born at 40 weeks by emergency caesarean section. The mother was a healthy 18 year old woman. His birth weight was 2.1 kg and his head circumference 31.5 cm, both of which were below the 0.4th centile. Brain magnetic resonance imaging confirmed the presence of bilateral occipital cysts and periventricular calcification. Serology and urine tests showed congenital CMV infection. The child had a normal immune system for his age.
Eye examination revealed sheathing of the retinal vessels and haemorrhages, which involved the arcades and were more marked in the left eye (Fig 1A, B, C). Exudates were present in both eyes superior to the disc (Fig 1A). The following day the vasculitis in the left eye had progressed and was involving the macula. Treatment with ganciclovir 5 mg/kg/day intravenously was started in view of the active retinitis. One week after …
