A patient with scleroderma develops chronic retinal necrosis due to cytomegalovirus

Scleroderma can affect one part of the body or many systems at once.

Retinography of the posterior pole, showing granular retinitis with hemorrhage (asterisk) and venous (arrowhead) and arterial (arrows) vascular occlusion. (C) FAG showing venous (arrowheads) and arterial (arrows) vascular changes. Photo: Case Report. Spanish Society of Dermatology.

acute retinitis due cytomegalovirus (CMV) occurs mainly in patients with acquired immune deficiency syndrome (AIDS) who have severe immunodeficiency.

However, it may rarely occur due to immunosuppressive treatment in organ transplants, cancer or systemic steroid patients.

In other cases, CMV retinitis may occur in immunocompetent patients with some type of immune dysfunction, such as old age, diabetes, or the use of steroids or non-cytotoxic immunosuppressants.

There is a lot of talk about the immunological role in patients with rheumatic diseases, such as those in a 52-year-old woman diagnosed with sclerodermamixed connective tissue disease, interstitial lung disease and severe malnutrition due to esophageal involvement with prednisone, mycophenolate and hydroxychloroquine, which develops chronic retinal necrosis from cytomegalovirus.

Acute retinal necrosis is characterized by anterior granulomatous uveitis with vitreous and the appearance of one or more foci of full thickness, whitish retinal necrosis associated with peripheral periarteritis, which gradually progresses.

The authors of the case emphasize that it is important to recognize this rare form of CMV retinitis in HIV-negative patients, but with some kind of partial immunodeficiency, to start treatment as soon as possible, avoiding complications of this type of viral retinitis.

IN scleroderma is an immune-mediated rheumatic disease of the connective tissue that causes inflammation of the skin and other parts of the body. This causes hard and thick spots on the skin. IN scleroderma it can affect one part of the body or many systems at once.

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