|
Case:
A 52-year-old white man with a history of polycystic renal
disease was referred to our department in October 1998 for
evaluation of acute progressive retinopathy of unknown etiology,
which developed 5 months after he received a renal transplant
(in May 1998) from a nonrelated living donor. |
| Symptoms |
| The
patient reported having experienced sudden, bilateral, painless,
blurred vision while watching television, with vision “troubles”
1 week earlier. Because of his sudden loss of vision, the
patient required assistance to carry out daily activities.
The patient reported no history of trauma, cold extremities,
fever, paresthesia, hearing loss, extensive bruising, bleeding
problems, or rashes. |
|
Medical
Regimen at Onset of Symptoms
|
| |
|
|
|
|
| prednisone,
10 mg, po, qd |
|
tamsulosin hydrochloride, 0.4 mg, po,
qd |
| acyclovir,
800 mg, po, bid |
|
furosemide, 40 mg, po, qd |
| cyclosporine
(4.25mg/kg/d), 150 mg, po, bid |
|
amlodipine besylate, 5 mg, po, qd |
| mycophenolate
mofetil, 1000 mg, po, bid |
|
aspirin, 81 mg, po, qd |
| trimethoprim
(160 mg) - sulfamethoxazole (800 mg), po, qd |
|
temazepam, 15 mg, po, qh |
| clotrimazole,
10 mg, po, qid |
|
nicotinic acid (niacin), 200 mg, po, bid |
| Cernevit
(multivitamin), 5ml injection IV, qd |
|
alodrenate sodium, 10 mg, po, qd |
| omeprazole,
20 mg, po, qd |
|
digoxin, 0.125 mg, po, qd |
|
|
- Around the time of the renal transplantion, the
patient had been given 2 doses of basiliximab, a
monoclonal chimeric antibody directed against the
IL-2 receptor, as well as an intravenous injection
of glucagon 12 hours before the onset of symptoms.
|
|
| Past
Medical History |
| In
addition to polycystic renal disease and renal transplantation,
the patient’s past medical history was notable for long-standing
diagnosis of hypertension (10 years), hepatitis C without
active hepatitis, a frozen left vocal cord (1996) with spontaneous
resolution after 6 months, and steroid-induced acne. |
| Diagnosis
& Treatment Before
Initial Examination |
| CMV
retinitis was diagnosed. Oral acyclovir was withdrawn and
intravenous ganciclovir administered, but the patient’s
visual acuity progressively deteriorated. |
|
|
