Cytomegalovirus Retinitis as a Sole Manifestation of HIV Infection.

Cláudia Ferreira Tátá,Rui Matono,Claudiu Guz,Tiago Ramires,Maria Piteira

doi:10.7759/cureus.18642

Abstract

Retinitis is the most frequent manifestation of Cytomegalovirus (CMV) disease in patients with HIV infection. The virus reaches the retina by hematogenous spread, therefore patients with serum CMV load are at increased risk of developing CMV retinitis. The evolution of retinitis without specific treatment causes irreversible visual loss. Proper treatment is essential for controlling the disease progression, prevention of relapses, and contralateral eye involvement.This report describes a 56-year-old white male who started a progressive decrease in visual acuity (VA) of the right eye, without pain or inflammatory signs. Initial fundoscopy identified a dispersed preretinal hemorrhage and yellowish exudates. For the hypothesis of CMV retinitis, serology for HIV was requested and the subsequent result was positive. Other opportunistic infections, as well as manifestations of CMV infection in other organs, were ruled out. The patient was discharged on valganciclovir and highly active antiretroviral therapy (HAART) with progressive improvement in retinal changes, but without full recovery from VA due to chronic vitritis and tractional retinal detachment. Slow recovery of lymphocyte populations and sustained decrease in viral load were observed.CMV retinitis as an initial and sole manifestation of HIV infection is rare and requires screening. The importance of this case lies in its rarity, since CMV retinitis was the only manifestation of CMV infection and the only opportunistic infection in this patient. Early diagnosis and initiation of targeted therapy decrease the morbidity associated with this infection.

Highlights

Cytomegalovirus (CMV) retinitis is the most common sight-threatening intraocular infection in HIV-infected patients
CMV retinitis as an initial and sole manifestation of HIV infection is rare and requires screening. The importance of this case lies in its rarity, since CMV retinitis was the only manifestation of CMV infection and the only opportunistic infection in this patient
With highly active antiretroviral therapy (HAART), the prevalence of CMV retinitis has decreased by about 80 to 90%, currently occurring mainly in cases of advanced immunosuppression, usually in patients with CD4+ T lymphocyte counts below 100 cells/mm3, that are not complying with HAART, present resistance, or that do not respond to this therapy [3]

Summary

Introduction

Cytomegalovirus (CMV) retinitis is the most common sight-threatening intraocular infection in HIV-infected patients. While waiting for an appointment, he presented a rapidly progressive worsening of his VA and resorted to the Emergency department Upon observation, he maintained alterations in the retinography of the RE, with worsening of pre-retinal hemorrhage and yellowish exudates, with no other findings (Figure 1). He was admitted to the Internal Medicine department, assuming the diagnostic hypothesis of CMV retinitis as the first manifestation of HIV infection and starting IV ganciclovir empirically. Confirmed CMV and HIV-1 infection, with criteria of AIDS, in stage C, according to the classification proposed by CDC Atlanta for patients infected with HIV He started HAART with tenofovir, emtricitabine and efavirenz, and Pneumocystis jirovecii pneumonia prophylaxis. Pneumocystis jirovecii pneumonia prophylaxis was discontinued, maintaining HAART, valciclovir, and serial ophthalmology follow-ups

Discussion

Conclusions

Disclosures

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