To report a case of acute retinal necrosis presumably caused by cytomegalovirus (CMV) following transverse myelitis.

Case Summary:

A 62 year-old man was referred to our clinic with a history of progressive visual loss in both eyes (BE) within 2 weeks. Ocular history was unremarkable so far. Medical history revealed transverse myelitis, and he had pulse steroid treatment about a month ago. His visual acuity was 0.6 in BE. Anterior segment exam showed a 1+ cell reaction in anterior chamber. Fundus exam showed bilaterally a moderate vitritis, vasculitis and extensive perivascular retinitis with areas of hemorrhages and whitening extending from the peripheral retina to the vascular arcades. Our diagnosis was acute retinal necrosis. Intravenous acyclovir therapy was started. Initial laboratory tests were performd with CBC, liver function, BUN/creatinine, HSV 1 and 2, CMV and FTA-ABS. The results were specific for a positive CMV-antibody titer only. Blood-PCR testing was positive for CMV also. Patient refused a diagnostic vitreous and anterior chamber tap. Based on these results medication was switched from acyclovir to ganciclovir. At day 21 after diagnosis, there was a complete regression of retinal necrosis in BE. However, proliferative vitreoretinopathy developed with tractional retinal detachments and visual acuity dropped to 20/200 in the RE and CF in the LE. Bilateral pars plana vitrectomy was recommended, but the patient refused any operation.


Although we were unable to confirm CMV-infection with a diagnostic tap, diagnosis of acute retinal necrosis syndrome caused by CMV is most likely. CNV-related acute retinal necrosis is rare in immune-competent patients. The preceding transverse myelitis with mega-dose steroid therapy has problably contributed to the manifestation of CMV-related retinitis.