Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia
Rodrigues, F., Paiva, A., Valdez, C., de Melo Bento, C., de Andrade, R. (2018). Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia. EKB Journal Management System, 8(2), 103-104. doi: 10.21608/aeji.2018.8743
Felipe Tavares Rodrigues; Alexandre de Carvalho Paiva; Catherine da Cal Valdez; Cleonice Alves de Melo Bento; Regis Mariano de Andrade. "Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia". EKB Journal Management System, 8, 2, 2018, 103-104. doi: 10.21608/aeji.2018.8743
Rodrigues, F., Paiva, A., Valdez, C., de Melo Bento, C., de Andrade, R. (2018). 'Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia', EKB Journal Management System, 8(2), pp. 103-104. doi: 10.21608/aeji.2018.8743
Rodrigues, F., Paiva, A., Valdez, C., de Melo Bento, C., de Andrade, R. Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia. EKB Journal Management System, 2018; 8(2): 103-104. doi: 10.21608/aeji.2018.8743

Cytomegalovirus Retininis in a Patient with Waldenstrom Macroglobulinemia

Afro-Egyptian Journal of Infectious and Endemic Diseases
Article 6, Volume 8, Issue 2, June 2018, Page 103-104  XML PDF (317.32 K)
Document Type: Case report
DOI: 10.21608/aeji.2018.8743
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Authors
Felipe Tavares Rodrigues email 1; Alexandre de Carvalho Paiva2; Catherine da Cal Valdez2; Cleonice Alves de Melo Bento3; Regis Mariano de Andrade3
1Graduate Student of Escola de Medicina e Cirurgia do Rio de Janeiro- UNIRIO, Brazil
2Physician at Hospital Universit?rio Gafrée e Guinle- UNIRIO, Brazil
3Professor of Universidade Federal do Estado do Rio de Janeiro – UNIRIO, Brazil.
Abstract
A 62-years-old woman presented with microcytic hypochromic anemia, diffuse adenopathy, , and hepatosplenomegaly, was diagnosed as having Waldenst?m Macroglobulinemia by blood serum electrophoresis which detected a IgM-KAPPA monoclonal gammopathy, besides the results of  immuno-phenotypic characteristics of neoplastic B-lymphocytes present in bone marrow positive for CD19, CD20, FMC7, CD79; and not reactive for CD23, CD5 and CD38. MYD88 mutation was absent. The patient underwent a week intermittent chemotherapy (oral scheme: Predinisone Session [CurrentTestPartID] mg and Chlorambucil 2 mg during 5 months) and then, without adequate therapeutic response, it was reset including intra-venous anti-CD20 monoclonal immunoglobulin (Rituximab, for 4 months). The patient had a good response to the therapy. However, almost a year after Rituximab scheme started, patient complained of sudden decrease of visual acuity (20/200) according to the Snellen chart with floaters, only in the left eye. CD4 T cell count was 205 cells/mm3, relatively reduced when compared to a health person because of the chronic use of immunosuppressant drugs and the down modulation due to the inflammatory stress state seen at a hematological lymphoproliferative disease. Fundoscopy findings were compatible with CMV retinitis , confirmed by CMV-DNA PCR in plasma samples with a high viremia (3.102 copies/mL). Plasma cytokines were measured to see the inflammatory response Intravenous Ganciclovir 500mg every 12 hours for 2 weeks was administered. Granulocyte colony-stimulating factor was used to manage neutropenia. Visual acuity improvement was observed (20/40).
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