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A Case of Cytomegalovirus Retinitis during Maintenance Chemotherapy for Acute Leukemia

Pediatric Infectioon & Vaccine 2020년 27권 3호 p.198 ~ 204
안빈, 송승하, 한미선, 오백록, 최재홍, 최은화,
소속 상세정보
안빈 ( Ahn Bin ) - Seoul National University Hospital Department of Pediatrics
송승하 ( Song Seung-Ha ) - Seoul National University Hospital Department of Pediatrics
한미선 ( Han Mi-Seon ) - Seoul National University Hospital Department of Pediatrics
오백록 ( Oh Baek-Lok ) - Seoul National University Hospital Department of Ophthalmology
최재홍 ( Choi Jae-Hong ) - Jeju National University Hospital Department of Pediatrics
최은화 ( Choi Eun-Hwa ) - Seoul National University Hospital Department of Pediatrics

Abstract


Cytomegalovirus (CMV) disease is rare in children who receive anticancer chemotherapy and have no history of stem cell transplantation (SCT). We report a case of CMV retinitis that developed during maintenance chemotherapy for acute leukemia. A 7-year-old boy developed decreased visual acuity and persistent pancytopenia during maintenance chemotherapy. Laboratory investigations initially showed significant CMV antigenemia (51 positive cells/200,000 leukocytes); however, antiviral therapy was not deemed necessary in this patient who had no history of SCT. CMV antigenemia worsened to 170 positive cells/200,000 leukocytes over 3 weeks. Ophthalmological examination revealed multiple bilateral retinal infiltrates and granular lesions. He was diagnosed with CMV retinitis and was treated with a 4-week course of intravenous ganciclovir and intravitreal injection of ganciclovir 6 times, followed by a 1-month course of orally administered valganciclovir. A CMV antigenemia assay showed negative results, and follow-up fundoscopy revealed lesser retinal infiltration after the sixth intravitreal ganciclovir injection. Future studies should focus on the development of standardized screening methods and preemptive therapeutic strategies for CMV disease in high-risk children.

키워드

Cytomegalovirus; Retinitis; Chemotherapy

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