Abstract
Cytomegalovirus (CMV) retinitis may occur in profoundly immunocompromised patients and be the initial AIDS-defining infection. The incidence and prevalence of CMV retinitis has declined substantially in the era of highly active antiretroviral therapy (HAART); nevertheless, it remains a leading cause of ocular morbility. We report the case of a 40-year-old man with blurred vision and pain in the right eye, three weeks after the initiation of effective HAART treatment. Ocular examination revealed a panuveitis causing an anterior chamber reaction with hypopyon and a dense vitreous haze. An endogenous endophthalmitis was suspected and treatment was ensued, without improvement. A vitreous tap was performed, and a positive polymerase chain reaction for CMV was found. A diagnosis of immune recovery uveitis (IRU) was made, and the patient responded to treatment with valganciclovir and dexamethasone. IRU is an intraocular inflammation that develops in patients with HAART-induced immune recovery and inactive CMV retinitis, although cases of active CMV retinitis have been described. Presentation with panuveitis and hypopion is rare and may be misleading regarding diagnosis and management.
Highlights
Cytomegalovirus (CMV) retinitis is a common opportunistic disease among patients with acquired immunodeficiency syndrome (AIDS) and typically manifests itself as progressive necrotizing retinitis with little or no intraocular inflammation [1,2,3,4]
We report a case of severe immune recovery uveitis (IRU) with active CMV retinitis in a 40-year-old male infected with human immunodeficiency virus (HIV) and no known previous ophthalmological examination
IRU is a noninfectious intraocular inflammation which develops in patients with CMV retinitis who have a substantial increase in CD4+ T-lymphocyte several weeks after starting highly active antiretroviral therapy (HAART), even though it may develop months to years after an immune recovery with HAART
Summary
Cytomegalovirus (CMV) retinitis is a common opportunistic disease among patients with acquired immunodeficiency syndrome (AIDS) and typically manifests itself as progressive necrotizing retinitis with little or no intraocular inflammation [1,2,3,4]. Due to the advent of highly active antiretroviral therapy (HAART), many patients may experience an immune reconstitution syndrome that can manifest itself as an ocular inflammatory response, termed immune recovery uveitis (IRU). This inflammatory response to CMV retinitis is a significant cause of visual morbidity in patients with AIDS [6,7,8,9]. When HAART was initiated, he developed signs of severe intraocular inflammation with panuveitis and hypopyon
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