DOI: 10.12890/2026_006826

Isolated cytomegalovirus optic neuritis in an immunocompetent patient

Authors

  • Vasileios Petrakis Department of Infectious Diseases, 2nd University Department of Internal Medicine, University General Hospital Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
  • Christina Aggelopoulou Department of Neurology, University General Hospital Alexandroupolis, Alexandroupolis, Greece
  • Georgios Tartanis Department of Neurology, University General Hospital Alexandroupolis, Alexandroupolis, Greece
  • Soultana Tsakaldimi Department of Neurology, University General Hospital Alexandroupolis, Alexandroupolis, Greece
  • Maria Panopoulou University Laboratory of Microbiology, University General Hospital Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
  • Anastasia Grapsa Laboratory of Biopathology, University General Hospital Alexandroupolis, Alexandroupolis, Greece
  • Periklis Panagopoulos Department of Infectious Diseases, 2nd University Department of Internal Medicine, University General Hospital Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece

vasilispetrakis1994@gmail.com

Keywords

Cytomegalovirus, optic neuritis, immunocompetent, papillitis, neuro-ophthalmology

Abstract

Introduction: Cytomegalovirus (CMV) typically causes asymptomatic or mild, self-limiting infections in immunocompetent individuals. Severe end-organ disease, particularly isolated central nervous system or ocular involvement, is associated with significant immunosuppression. Isolated optic neuritis due to CMV in a healthy, immunocompetent host is a rare clinical entity, which can lead to delayed diagnosis and potential vision loss.
Case description: We report a rare case of a previously healthy 25-year-old male who presented with a 3-day history of intermittent right retrobulbar pain and was found to have early bilateral optic disc oedema. Best-corrected visual acuity was 9/10 in the right eye, with normal colour vision and no relative afferent pupillary defect. An extensive neurological, immunological, and infectious disease workup was negative for autoimmune and demyelinating conditions. However, serological testing revealed positive immunoglobulin M and immunoglobulin G titres for CMV. Concurrent polymerase chain reaction (PCR) testing detected CMV viremia in both blood and cerebrospinal fluid (CSF), confirming an active CMV infection with central nervous system involvement. The patient was treated with high-dose intravenous corticosteroids and systemic antiviral therapy with valganciclovir leading to a complete clinical and anatomical recovery and no clinical relapse during the follow-up period.
Conclusion: This case highlights that severe CMV neuroretinal manifestations can occur in strictly immunocompetent patients. Prompt molecular diagnostic testing, specifically CSF and blood PCR, is crucial when atypical optic neuritis is encountered. A combined regimen of antiviral therapy and high-dose corticosteroids represents a highly effective, organ-saving approach for managing CMV-induced optic neuritis.

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References

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Published

2026-06-03

Issue

Vol. 13 No. 7 (2026)

Categories

How to Cite

1.
Petrakis V, Aggelopoulou C, Tartanis G, Tsakaldimi S, Panopoulou M, Grapsa A, et al. Isolated cytomegalovirus optic neuritis in an immunocompetent patient. EJCRIM [Internet]. 2026 Jun. 3 [cited 2026 Nov. 3];13(7). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6826

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