Cytomegalovirus retinitis in the absence of HIV or immunosuppression D.J. SLOAN 1,2 , M. TAEGTMEYER 1,2 , I.A. PEARCE 3 , I.J. HART 4 , A.R.O. MILLER 1,2 , N.J. BEECHING 1,2 1 Tropical and Infectious Disease Unit, Royal Liverpool University Hospital 2 Liverpool School of Tropical Medicine 3 St Pauls Eye Unit, Royal Liverpool University Hospital 4 Department of Virology, Royal Liverpool University Hospital, Liverpool - UK INTRODUCTION Cytomegalovirus (CMV) is associated with sight-threaten- ing retinitis in human immunodeficiency virus (HIV) infec- tion at CD4+ counts below 50 cells/μL. Systemic steroids are an independent risk factor for the development of clinical disease in this group (1). Less commonly, non-HIV related CMV retinitis occurs in transplant recipients or heavily immunosuppressed patients with autoimmune European Journal of Ophthalmology / Vol. 18 no. 5, 2008 / pp. 813-815 1120-6721/813-03$25.00/0 © Wichtig Editore, 2008 PURPOSE. Cytomegalovirus (CMV) retinitis classically occurs in advanced human immunod- eficiency virus (HIV) infection but is rare in other forms of immunosuppression. The authors report a case of CMV retinitis in an HIV-negative man with idiopathic CD4 lymphocytope- nia (ICL). This is the first such case to be confirmed by polymerase chain reaction (PCR) of aqueous humor. METHODS. Case report. RESULTS. A 69-year-old retired Chinese seaman presented with gradual visual deterioration. He was a diet controlled diabetic on regular steroids for presumed asthma. Examination showed no diabetic eye disease but confirmed acute retinal necrosis (ARN). Anterior cham- ber tapping of the aqueous humor was PCR positive for CMV. HIV antibody and RNA tests were negative but his full blood count revealed lymphocytopenia, with a low CD4+ subset. He responded to a 3-week course of intravenous ganciclovir therapy followed by suppres- sive oral valganciclovir. CONCLUSIONS. CMV is associated with sight-threatening retinitis in HIV infection at CD4+ counts below 50 cells/μL and in transplant recipients or heavily immunosuppressed pa- tients. Systemic steroids are a risk factor for clinical disease in these groups. It is extremely rare to report CMV eye disease in previously healthy individuals. This case illustrates that the condition does occur in association with ICL. Corticosteroids may be implicated in dis- ease reactivation. Molecular methods are necessary to confirm the diagnosis. (Eur J Oph- thalmol 2008; 18: 813-5) KEY WORDS. Cytomegalovirus, Retinitis, HIV negative, CD4 lymphocytopenia, Corticosteroids Accepted: March 16, 2008 SHORT COMMUNICATIONS & CASE REPORTS disease (2). It is extremely rare to report CMV eye disease in previously healthy individuals and corticosteroids have been implicated as the sole immunomodulatory factor on only three occasions (3-5). We present a case of acute retinal necrosis (ARN) sec- ondary to confirmed CMV infection in an HIV-negative man on low dose steroids for asthma with a presenting CD4+ count of 65 cells/μL. The explanation for his lymphocytope- nia and issues concerning ongoing therapy are discussed.