Cytomegalovirus Retinitis Mimicking Intraocular Lymphoma Recurrence Following Combined Autologous Transplantation and CAR-T cell Therapy

PURPOSE: To describe an unusual case of cytomegalovirus (CMV) retinitis presenting with significant vitreous inflammation in a lymphoma patient following combined autologous transplantation and chimeric antigen receptor (CAR) T cell therapy. METHODS: This is a retrospective case report. The case was evaluated with multimodal ophthalmic imaging, and the diagnosis was established based on cytological and virological tests. RESULTS: A 54-year-old male with primary diffuse large B cell lymphoma of the cervical lymph nodes experienced monocular visual loss one month after combined autologous hematopoietic stem cell transplantation and CAR-T cell therapy. Initial examination revealed significant vitreous inflammation, mimicking intraocular lymphoma relapse. After the removal of dusty vitreous in the subsequent diagnostic vitrectomy, extensive retinal vascular occlusion emerged as the key feature with minimal retinal lesions. Cytological and virological studies of the vitreous sample excluded intraocular lymphoma and confirmed CMV retinitis. CONCLUSION: This case highlights prominent vitritis as an atypical presentation of CMV retinitis. This report broadens the recognized clinical spectrum of CMV retinitis, underscoring the necessity of considering CMV retinitis in the differential diagnosis of vitreous inflammation, particularly in lymphoma patients with complex immune statuses.