Bilateral necrotising retinitis caused by cytomegalovirus in an immunocompetent host: A case report

Abstract

Retinal necrosis (RN) is typically caused by herpesviridae, most commonly varicella-zoster virus (VZV), followed by HSV and occasionally cytomegalovirus (CMV). While RN is generally unilateral, bilateral cases are more common in immunocompromised individuals. We report a rare case of bilateral retinal necrosis caused by CMV in an immunocompetent 31-year old male. He initially presented with defective vision in both eyes and was diagnosed after PCR confirmed the CMV as the causative agent. Despite initial treatment with intravenous acyclovir, he showed persistent vitreous inflammation with membranes, leading to intravitreal ganciclovir injections. While the patient experienced significant improvement, complications such as a macular hole and epiretinal membrane developed. This case highlights the need for clinicians to consider CMV as a possible cause of RN in immunocompetent adults, especially in non-responding cases, and underlines the importance of early etiological diagnosis and targeted treatment.