A rare case of cytomegalovirus papillitis in patient with immunodeficiency
AbstractA 26-year-old male diagnosed with AIDS came with sudden blurred vision and central sco-toma in left eye since 2 weeks before admission. His visual acuity was counting finger at 5 meters with normal IOP and anterior segment. The posterior segment revealed edematous optic nerve covered by exudates and hemorrhages. Due to low CD4+ count and serological test result, we considered a HIV-related opportunistic ocular infection, specifically HSV infection. As visual acuity worsened during treatment with acyclovir, we performed PCR ex-amination from aqueous tap which revealed positive CMV DNA. Unfortunately, the visual acuity had worsened to no light perception before he received any specific anti-CMV agent. CMV papillitis is an unusual presentation of CMV retinitis. PCR examination from aqueous or vitreous tap should be performed while waiting for serological test result, especially in doubtful cases. Therefore, appropriate diagnosis and management can be established early to prevent irreversible visual loss.
Patel SS, Rutzen AR, Marx JL, Thach AB, Chong LP, Rao NA. Cytomegalovirus papilltis in patients with acquired immune deficiency syndrome. Visual prognosis of patients treated with ganciclovir and/or foscarnet. Ophthalmology. 1996;103(9):1476–82. http://dx.doi.org/10.1016/S0161-6420(96)30480-6
Lestari YD. Prevalensi manifestasi okular human immunodeficiency virus/acquired immunodeficiency syndrome di DKI Jakarta. [Thesis]. Jakarta: Univesitas Indonesia; 2009. p.3–5. Indonesian.
Moorthy RS, Rao PK, Read RW, Gelder RN, Vitale AT, Bodaghi B, et al. Infectious ocular inflammatory diseases. In: Skuta GL, Cantor LB, Weiss JS, editors. Intraocular inflamation and uveitis. San Fransisco: American Academy of Ophthalmology; 2011-2012. p. 204–7.
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed (February 13, 2014). p. N1–8.
Bentwich Z. Concurrent infections that rise the HIV viral load. J HIV Ther. 2003;8(3):72–5.
Iqbal TB. HIV-related eye condition. In: Menon A, Kamarulzaman A, editors. Is it HIV? A hand-book for health care provider Thailand: The Australian Society for HIV Medicine (ASHM);KP Marketing.Darlinghurst: 2009. p. 46–51.
Cullen C, Matlala B, Laher F, Pienaar A. Successful treatment of bilateral visual loss caused by idiopathic optic neuritis in an HIV-infected patient. The Southern African Journal of HIV Medicine 2011;12(4). http://dx.doi.org/10.4102/hivmed.v12i4.169
De Silva SR, Chohan G, Jones D, Hu M. Cytomegalovirus papillitis in an immunocompetent patient. J Neuroophthalmol. 2008;28(2):126–7. http://dx.doi.org/10.1097/WNO.0b013e3181782fed
Freeman W, Lerner CW, Mines JA, Lash RS, Nadel AJ, Starr MB. A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome. Am J Ophthalmol. 1984;97(2):133–42. http://dx.doi.org/10.1016/S0002-9394(14)76082-9
Gross JG, Sadun AA, Wiley CA, Freeman WR. Severe visual loss related to isolated peripapillary retinal and optic nerve head cytomegalovirus infection. Am J Ophthalmol. 1989;108(6):691–8. http://dx.doi.org/10.1016/0002-9394(89)90863-5
Rosecan LR, Stahl-Bayliss CM, Kalman CM, Laskin OL. Antiviral therapy for cytomegalovirus retinitis in AIDS with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986;101(4):405–18. http://dx.doi.org/10.1016/0002-9394(86)90638-0
Roarty J, Fisher EJ, Nussbaum JJ. Long-term visual morbidity of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. Ophthalmology. 1993;100(11):1685–8. http://dx.doi.org/10.1016/S0161-6420(93)31417-X
Palestine AG, Stevens Jr G, Lane HC, Masur H, Fujikawa LS, Nussenblatt RB, et al. Treatment of cytomegalovirus retinitis with dihydroxy propoxymethyl guanine. Am J Ophthalmol. 1986;101(1):95–101. http://dx.doi.org/10.1016/0002-9394(86)90470-8
Figueiredo L, Rothwell R, Bilhoto M, Varandas R, Fonseca S. Immune recovery uveitis masked as an endogenous endophthalmitis in a patient with active CMV retinitis. Case Rep Ophthalmol Med. 2013;2013: Article ID 462968.p1–4 http://dx.doi.org/10.1155/2013/462968
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed (February 13, 2014). p N9–15.
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