Bilateral arteritis with cytomegalovirus retinitis in a patient infected with human immunodeficiency virus.

Abstract

To report an interesting ocular finding and course of bilateral arteritis with cytomegalovirus retinitis in a patient infected with the human immunodeficiency virus (HIV). Retrospective single case report. A 39-year-old HIV-positive man on highly active antiretroviral therapy presented with a history of diminution of vision in both eyes of 1-month duration. Fundus examination showed vitritis, sheathing, and a cordlike appearance of the arteries with veins unaffected in both eyes. A patch of cystomegalovirus retinitis was noted temporally in the right eye. Fluorescein angiography showed gross areas of capillary nonperfusion in both eyes. Polymerase chain reaction of the aqueous tap was positive for cytomegalovirus in both eyes. Despite aggressive treatment with intravitreal ganciclovir followed by a course of intravenous ganciclovir, the right eye progressed to neovascularization, vitreous hemorrhage, neovascular glaucoma, and no perception of light. Segmentation and recanalization of arteries were noted in the left eye. Immune recovery uveitis developed in the left eye after 2 months and was treated with oral steroids and intravenous ganciclovir followed by a maintenance dose of valganciclovir. At 3 years follow up, his vision and ocular condition in the left eye is stable. An interesting finding of bilateral arteritis with cystomegalovirus retinitis in an HIV-positive patient is reported. The arteritis did not respond very well to intravitreal ganciclovir and required a course of intravenous ganciclovir. Early treatment with intravenous ganciclovir and laser photocoagulation in such cases may reduce visual morbidity.