急性リンパ性白血病の維持療法中に合併したサイトメガロウイルス網膜炎の１例

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  • Successful Treatment of Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy.

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We report a case of a 7-year-old girl with acute lymphoblastic leukemia who developed cytomegalovirus (CMV) retinitis during maintenance chemotherapy. She complained of blurred vision in her left eye.Ophthalmoscopic examination of the fundus revealed the “cheese-and-ketchup” pattern characteristic of CMV retinitis. CMV was detected in anterior chamber fluid by polymerase chain reaction, and in blood by antigenemia assay. The patient's blurred vision disappeared, and the ophthalmoscopic findings were resolved after stopping maintenance chemotherapy and treatment with gancyclovir. The patient had lymphocytopenia and a decreased number of CD4-positive lymphocytes for a year. These data suggested that cellular immunodeficiency was critical in the development of retinitis. We propose that when CD4-positive lymphocyte counts are low during maintenance chemotherapy, immediate ophthalmologic examination and CMV testing is warranted in cases with disturbances of visual acuity.

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