Delayed recognition and therapeutic misdirection in cytomegalovirus corneal endotheliitis: A case series from Vietnam
- 1Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
- 2Cornea Department, Ho Chi Minh City Eye Hospital, Ho Chi Minh City, Vietnam
Abstract
Background: In immunocompetent adults, cytomegalovirus (CMV) corneal endotheliitis shares clinical features with herpesvirus-associated endotheliitis, anterior uveitis, and Posner–Schlossman syndrome, so the diagnosis is easily misdirected in our patients for periods ranging from one month to two years. Aqueous humor polymerase chain reaction (PCR), the test that establishes the etiology, is invasive and carries a non-trivial cost, so clinicians often hesitate to request it, further prolonging the time to a correct diagnosis.
Case series: We report six immunocompetent adults who experienced delayed diagnosis and deferred targeted therapy for CMV corneal endotheliitis at Ho Chi Minh City Eye Hospital. The primary objective of this report is to delineate the distinct clinical trajectories culminating in misdiagnosis. Across these diagnostic pathways, patients sustained dual ocular harm: unabated progression of CMV endotheliitis alongside treatment-related ocular toxicity from prolonged, non-targeted empirical regimens. Aqueous humor PCR confirmed CMV infection in all patients, with one case demonstrating concomitant methicillin-resistant Staphylococcus aureus positivity. Due to substantial financial constraints, access to oral valganciclovir was markedly restricted, whereas topical 0.15% ganciclovir proved insufficient for advanced disease. These cases highlight critical economic dilemmas governing both etiologic investigation—specifically the selective use of qualitative versus quantitative PCR assays—and therapeutic accessibility in resource-limited settings.
Conclusion: CMV should be regarded as a mandatory differential diagnosis in the relevant clinical presentations, whether as the primary cause or as a secondary reactivation during topical corticosteroid or glaucoma therapy. Aqueous humor PCR should be viewed as a cost-saving investigation obtained early, rather than a test reserved for after empirical treatment has failed.
Related
- From Molecular Pathogenesis to Therapeutic Innovations in Human Cytomegalovirus Research
- M11‐CAR T cells inhibit murine cytomegalovirus in vitro upon recognition of virion‐ and cell‐associated glycoprotein B
- Advanced Carcinoid Tricuspid Valve Disease Associated with Delayed Recognition and Loss of the Interventional Window in a Patient with Ileal Neuroendocrine Tumor: A Case Report
- Delayed recognition of primary thyroid lymphoma with progressive thyroid enlargement and cardiopulmonary symptoms.
- Delayed Recognition of Autism Spectrum Disorder and Off-Label Lurasidone After Intolerance to Risperidone and Aripiprazole in a Latin American Child: A Case Report
BibTeX
@article{nguyen2026delayed,
title = {{Delayed recognition and therapeutic misdirection in cytomegalovirus corneal endotheliitis: A case series from Vietnam}},
author = {Thi Ngoc Tham Nguyen and Nguyen Huong Thao Vo and Nguyen Hoan Huy Lam},
journal = {IDCases},
year = {2026},
month = oct,
doi = {10.1016/j.idcr.2026.e02818},
url = {https://doi.org/10.1016/j.idcr.2026.e02818},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Delayed recognition and therapeutic misdirection in cytomegalovirus corneal endotheliitis: A case series from Vietnam
AU - Thi Ngoc Tham Nguyen
AU - Nguyen Huong Thao Vo
AU - Nguyen Hoan Huy Lam
PY - 2026
DA - 2026/10/23
JO - IDCases
DO - 10.1016/j.idcr.2026.e02818
UR - https://doi.org/10.1016/j.idcr.2026.e02818
AB - Background: In immunocompetent adults, cytomegalovirus (CMV) corneal endotheliitis shares clinical features with herpesvirus-associated endotheliitis, anterior uveitis, and Posner–Schlossman syndrome, so the diagnosis is easily misdirected in our patients for periods ranging from one month to two years. Aqueous humor polymerase chain reaction (PCR), the test that establishes the etiology, is invasive and carries a non-trivial cost, so clinicians often hesitate to request it, further prolonging the time to a correct diagnosis. Case series: We report six immunocompetent adults who experienced delayed diagnosis and deferred targeted therapy for CMV corneal endotheliitis at Ho Chi Minh City Eye Hospital. The primary objective of this report is to delineate the distinct clinical trajectories culminating in misdiagnosis. Across these diagnostic pathways, patients sustained dual ocular harm: unabated progression of CMV endotheliitis alongside treatment-related ocular toxicity from prolonged, non-targeted empirical regimens. Aqueous humor PCR confirmed CMV infection in all patients, with one case demonstrating concomitant methicillin-resistant Staphylococcus aureus positivity. Due to substantial financial constraints, access to oral valganciclovir was markedly restricted, whereas topical 0.15% ganciclovir proved insufficient for advanced disease. These cases highlight critical economic dilemmas governing both etiologic investigation—specifically the selective use of qualitative versus quantitative PCR assays—and therapeutic accessibility in resource-limited settings. Conclusion: CMV should be regarded as a mandatory differential diagnosis in the relevant clinical presentations, whether as the primary cause or as a secondary reactivation during topical corticosteroid or glaucoma therapy. Aqueous humor PCR should be viewed as a cost-saving investigation obtained early, rather than a test reserved for after empirical treatment has failed.
SN - 2214-2509
ER -