Tofacitinib-associated cytomegalovirus retinitis
Dean Cugley, Jonathan Darby, Lyndell L. Lim
Abstract
Sir, Cytomegalovirus (CMV) retinitis has traditionally been associated with HIV infection, but other causes of immunocompromise may be risk factors in its pathogenesis. We present a unique case of tofacitinib-associated CMV retinitis (CMVR) in an HIV-negative patient with RA. A 54-year-old woman presented with a 5 day history of visual floaters in the right eye and 2 days of ocular injection and photophobia. Her RA was well controlled on methotrexate 15 mg/week, prednisolone 15 mg/day and tofacitinib 5 mg twice a day (Xeljanz, Pfizer, New York, NY, USA). Tofacitinib was commenced 10 months earlier, after failing adalimumab (Humira, AbbVie, Lake Bluff, IL, USA). The baseline lymphocyte count was normal (2.6 × 109 cells/l). Her medical history included type 2 diabetes mellitus treated with oral hypoglycaemics. The best corrected visual acuity (BCVA) on the right was 6/6 with an elevated intraocular pressure (47 mmHg), active panuveitis and occlusive retinal arteritis (see Fig. 1), with significant peripheral visual field loss from retinal ischaemia. The left eye was unremarkable (BCVA 6/6). She was systemically well, afebrile and haemodynamically stable.