Cytomegalovirus Retinitis in Immunosuppressed Hosts

Abstract

Cytomegalovirus (CMV) retinitis presents with typical ophthalmologic appearance in patients with underlying immunosuppressive conditions. Fourteen patients with this disorder were diagnosed by culture of CMV from urine or throat specimens, elevated complement fixation titers to CMV and characteristic funduscopic appearance. Ten of 11 had decreased CMV-specific cell-mediated immune responses. Of 7 who received no specific therapy, 3 improved after decreasing dosages of immunosuppressive drugs. Seven patients with progressive disease despite minimal immunosuppressive therapy were treated with adenine arabinoside (ara-A) at doses from 1-20 mg/kg of body weight per day. Daily dosages of 20 mg/kg in 5 patients were associated with decreased inflammatory activity, improvement of retinal lesions and quantitative decreases in urinary virus excretion. Ara-A administration was associated with significant gastrointestinal, hematologic and neurologic side effects. Ara-A may have some beneficial effect on selected patients with progressive CMV retinitis.