From latency to retinitis: reviewing the differences in pathogenesis of cytomegalovirus infection between children and adults after hematopoietic stem cell transplantation in three cases

Cytomegalovirus retinitis (CMVR) is a serious and potentially blinding complication following allogeneic hematopoietic stem cell transplantation (Allo-HSCT) in children. Currently, the understanding of this disease is largely derived from studies in adult populations, whereas the distinctive pathogenic features in pediatric patients remain inadequately elucidated. In this article, we analyzed three clinical cases of pediatric CMVR secondary to bone marrow transplantation and integrated these with a comprehensive literature review, systematically compared the core differences between children and adults from latent reactivation to end-organ damage in the pathogenic process of CMV. This organic integration of clinical observation and mechanistic exploration aims to remind clinicians that CMV reactivation and ocular complications in children may have distinct temporal characteristics and disease trajectories compared with adults, and we suggest that CMV monitoring should be initiated earlier in high-risk children and that ophthalmic screening should be performed as early as possible after the viremia.