An Unusual Cytomegalovirus Ocular Manifestation in a Non-HIV Patient

A 60-year-old Aboriginal man with underlying severe exfoliative dermatitis, treated with oral azathioprine and oral prednisolone, presented with left painful red eye for ten days. On initial presentation, left eye vision was poor at hand motion. There was corneal endotheliitis over the left eye with severe anterior chamber inflammation obscuring the fundus view. B-scan ultrasonography showed evidence of vitritis with a flat retina. An urgent aqueous tap for viral polymerase chain reaction (PCR) yielded positive cytomegalovirus (CMV) DNA results. As CMV infection commonly affects immunosuppressed individuals, his systemic immunosuppressants were withheld temporarily. He was successfully treated with combination intravenous ganciclovir, intravitreal ganciclovir 2mg/0.1ml, and topical ganciclovir 2%. His vision improved significantly from hand motion to 20/40. There was no reactivation of CMV infection post-treatment.