Exudative Diabetic-Radiation Retinopathy with Lipemia Retinalis Mimicking Cytomegalovirus Retinitis

Purpose: To describe a case in which a retinal lesion mimicking cytomegalovirus (CMV) retinitis prompted investigation that revealed severe hypertriglyceridemia as an associated factor in exudative diabetic and radiation retinopathy. Methods: Observational case report with multimodal imaging and aqueous PCR analysis. Results: A 38-year-old man with a history of leukemia, bone marrow transplantation, ocular and whole boddy irradiation, and type 1 diabetes presented for routine follow-up. A new granular retinal lesion raised suspicion for viral retinitis. Aqueous PCR testing for CMV, HSV, and VZV were negative. Systemic evaluation subsequently demonstrated triglycerides of 2,496 mg/dL. The findings were consistent with severe exudative diabetic and radiation retinopathy in the setting of extreme hypertriglyceridemia. He was treated with intravitreal bevacizumab and lipid-lowering therapy with observed improvement in retinal exudation, hemorrhages, and lipemia retinalis. Conclusion: A retinal lesion resembling CMV retinitis led to recognition of marked dyslipidemia associated with exudative retinopathy. Clinicians should be aware that dense, confluent exudation may mimic viral necrosis, and systemic lipid assessment is warranted in such cases.