A case series: cytomegalovirus retinitis following autologous hematopoietic cell transplantation: a call for early detection and aggressive management.

Background: Cytomegalovirus (CMV) retinitis represents a rare yet vision-threatening opportunistic infection following autologous hematopoietic cell transplantation (auto-HCT), typically arising in the setting of profound iatrogenic immunosuppression. While CMV reactivation is a well-documented post-transplant complication, the occurrence of retinitis remains uncommon, and its clinical course and risk profile in auto-HCT recipients are inadequately characterized. Our findings underscore a novel association with delayed immune reconstitution and propose a strategy for enhanced surveillance and preemptive intervention. Case presentation: Between November 2019 and January 2025, six patients who underwent auto-HCT for a range of hematologic malignancies were diagnosed with CMV retinitis. The median age at presentation was 63 years. All patients were seropositive for CMV-IgG prior to transplantation. The universal presenting symptom was visual impairment, manifesting as either decreased visual acuity or blurred vision. CMV DNAemia was detectable in four (66.7%) patients at diagnosis. Bilateral ocular involvement was noted in four (66.7%) cases. 66.67% patients had received high-dose corticosteroid therapy, and five (83.33%) had been treated with monoclonal antibodies prior to the onset of retinitis. A consistent immunological finding was persistent lymphopenia with markedly low CD4 Conclusion: CMV retinitis is an emerging and serious complication after auto-HCT, strongly correlated with prolonged immunosuppression-particularly from T-cell-depleting monoclonal antibodies and corticosteroids-resulting in sustained CD4