Combined vascular occlusion in peripapillary cytomegalovirus (CMV) retinitis

A 37-year-old female with known retroviral disease and CD4 count of 62 cells/mm3 was referred for diminution of vision in OS since 1 day and was found to have peripapillary cytomegalovirus (CMV) retinitis [Fig. 1a]. She had been started on intravenous ganciclovir 2 days back because of CMV gastroenteritis. Visual acuity in OS was 20/400. The patient was planned for intravitreal ganciclovir in view of peripapillary involvement. However, the patient presented the next day with further drop in vision. Visual acuity was light perception only. Repeat fundus evaluation of OS revealed tomato splash fundus with retinal whitening [Fig. 1b]. Optical coherence tomography showed retinal edema and hyperreflectivity of inner retinal layers [Fig. 1c], confirming combined vascular occlusion. Though severe visual loss due to focal destruction of the peripapillary nerve fiber layer and optic neuritis have been reported in peripapillary CMV retinitis, combined vascular occlusion has never been reported in peripapillary CMV retinitis to the best of our knowledge.[1,2]Figure 1: Color fundus photograph showing peripapillary CMV retinitis (a). One day later, typical picture of combined occlusion is seen on color fundus photograph (b) and optical coherence tomography (c). CMV = cytomegalovirusDeclaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.