Detection of cytomegalovirus in an immunocompetent adult presenting with acute retinal necrosis due to varicella-zoster virus: a case report

Abstract

Tomoko Nakamura,1 Tohru Daikoku,2 Kimiyasu Shiraki,2 Atsushi Hayashi11Department of Ophthalmology, 2Department of Virology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, JapanBackground: To report a case of simultaneous detection of cytomegalovirus (CMV) in acute retinal necrosis (ARN) due to varicella-zoster virus (VZV) in an immunocompetent adult.Methods: A 65-year-old healthy woman presented with necrotizing retinitis. Vitreous, tears, saliva, and swabs of the auricular and forehead skin areas were collected and tested by polymerase chain reaction analysis at various time points during the treatment period.Results: VZV and CMV DNA were detected in the vitreous, tears, saliva, and skin. CMV was present in fewer copies than VZV in the vitreous. The retinal lesion clinically improved rapidly only by acyclovir. According to the clinical findings and the clinical responses to acyclovir, CMV seems not to cause ARN in this case.Conclusion: VZV and CMV DNA were detected in the vitreous of a patient with VZV ARN. CMV reactivation appeared to be asymptomatic.Keywords: acute retinal necrosis, varicella-zoster virus, cytomegalovirus, polymerase chain reaction, immunocompetent patient