CMV retinitis in non-HIV immunocompromised individuals on tofacitinib for rheumatoid arthritis

To describe two patients with long-standing rheumatoid arthritis (RA) who developed cytomegalovirus (CMV) retinitis (CMVR) while taking tofacitinib. Retrospective case series. A 79-year-old woman with RA, treated with oral tofacitinib 11mg once daily, presented with blurred vision and pain in the right eye. Visual acuity (VA) was hand motion, anterior segment showed iritis and the intraocular pressure (IOP) was 35mmHg. Ophthalmoscopy revealed retinal hemorrhages and overlying vitreous hemorrhage. HIV serology was negative, serum CMV IgG was positive and aqueous polymerase chain reaction (PCR) was positive for CMV (802,000 IU/mL). An 82-year-old woman with a history of RA, treated with tofacitinib 11mg once daily, was referred for a white retinal lesion in the left eye. VA was 20/50, anterior segment was quiet and IOP was 23mmHg. Ophthalmoscopy revealed a yellow retinal lesion with ill-defined margins in the macula. She subsequently developed a new area of peripheral retinal whitening in the right eye. HIV serology was negative, serum CMV IgG was positive and aqueous PCR was positive for CMV (5,200,000 IU/mL). Diagnosis of CMVR in non-HIV individuals requires awareness of the risk of infectious retinitis in patients taking JAK inhibitors for the treatment of autoimmune disease.