Patient characteristics
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | |
|---|---|---|---|---|
| Systemic disease | ||||
| Diagnosis | Polyarteritis nodosa | SLE | SLE | Wegener’s granulomatosis |
| Age at diagnosis | 43 years | 38 years | 28 years | 71 years |
| Immunosuppressive therapy at presentation | Cyclophosphamide 100 mg/day | Azathioprine 50 mg/day | Azathioprine 150 mg/day | Cyclophosphamide 50 mg/day |
| Prednisolone 20 mg/day | Prednisolone 10 mg/day | Prednisolone 10 mg/day | Prednisolone 10 mg/day | |
| Previous immunosuppression | IV steroids and IV cyclophosphamide | Oral cyclophosphamide | IV and oral cyclophosphamide | Oral cyclophosphamide |
| Duration of therapy | 3 years | 10 years | 3 years | 3 years |
| Ocular features | ||||
| Presenting complaints | Floaters | Decreased vision | Blurred vision | Blurred vision |
| Vision | 6/12, 6/9 | 1/60, 6/9 | 6/18, 6/12 | 6/12-2, 6/9+2 |
| Ophthalmic diagnosis | cytomegalovirus retinitis | cytomegalovirus retinitis | cytomegalovirus retinitis | cytomegalovirus retinitis |
| Delay between onset of symptoms and diagnosis | 3–4 weeks | 3–4 weeks | 1.5–2 weeks | 5–6 weeks |
| Other ophthalmic findings | Nil | Inferior retinal detachment | Epiretinal membrane | Nil |
| Laterality | Bilateral | Unilateral | Bilateral | Unilateral |
| Investigations | ||||
| CMV antibodies in blood | Positive IgM (rising titres) | Positive IgG and IgM (rising titres) | Positive IgG and IgM (rising titres) | Positive IgM |
| Cytomegalovirus culture | Positive from urine and blood | Negative | Negative | Negative |
| PCR for cytomegalovirus | Not done | Negative | Negative | Positive for CMV |
| WBC (NR 4–13) | 3.9 | 17 | 7.6 | 3.1 |
| Lymphocyte (NR 1.5–4) | 0.2 | 0.5 | 0.72 | 0.3 |
| CD4 cell count (NR 0.41–1.54) | Not done | 0.12 | 0.26 | 0.02 |
| CD8 cell count (NR 0.23–1.09) | Not done | 0.28 | 0.25 | 0.21 |
| Treatment | ||||
| Changes to | Cyclophosphamide reduced to 50 mg | Azathioprine stopped, | Azathioprine stopped, | Cyclophosphamide stopped |
| immunosuppressive therapy | Prednisolone continued | Prednisolone reduced to 7.5 mg | Prednisolone continued | Prednisolone continued |
| Anticytomegalovirus therapy | IV ganciclovir | IV ganciclovir | IV ganciclovir | IV ganciclovir |
| Duration | 6 weeks | 3 weeks | 5 weeks | 4 weeks |
| Disease response | Quiescence | Quiescence | Quiescence | Quiescence |
| Recurrence | 2 further recurrence | Nil | Nil | Nil |
| Prophylaxis | IV ganciclovir | Oral ganciclovir | Oral ganciclovir | Oral ganciclovir |
| Duration of prophylaxis | 2.5 years | 3 months | 3.5 years | 2 months |
| Outcome | ||||
| Visual acuity at last review | 6/60, 6/36 | 1/60, 6/9 | 6/9, 6/9 | 6/12-2, 6/9+2 |
| Other ocular complication/procedures | Successful bilateral retinal reattachment surgery | Successful right retinal reattachment surgery | Nil | Nil |
| Present status | ||||
| CD4 cell (NR 0.41–1.54) | 0.55 (WBC 8.7, lymphocyte 4.2) | 0.36 | 0.48 | 0.04 |
| Immunosuppressive therapy | Nil | Prednisolone 7.5 mg/day | Prednisolone 7.5 mg/day, Azathioprine 100 mg/day | Prednisolone 10 mg/day |
| CMV prophylaxis | Nil | Nil | Nil | Oral ganciclovir |