Noncytomegalovirus-related chorio-retinal manifestations of the acquired immunodeficiency syndrome.

Abstract

The diagnosis of the ocular manifestations of AIDS is based initially on the clinical appearance of the lesions. However, retinal and choroidal lesions in AIDS patients are frequently the manifestation of disseminated disease. In one autopsy series, 15 of 18 patients with infectious choroiditis died of systemic infection by the same organism causing the choroiditis. Despite the fact that more than 90% of posterior segment infections in AIDS patients are caused by CMV, careful examination with appropriate consideration of differential diagnosis is necessary in all cases in which a classic pattern of CMV retinitis is not seen. Extensive history taking, discussion with the primary care physician, and the appropriate systemic work-up can greatly facilitate the diagnosis of the most likely cause of the apparent opportunistic infection. It is important to remember that noninfectious causes of HIV-related retinal disease can have a similar clinical pattern as infectious causes. In particular, physicians must be careful not to confuse early CMV retinitis with HIV-related noninfectious retinal vasculopathy, the most common retinal finding in patients with HIV disease. In a patient with multifocal superficial lesions in the posterior pole, particularly if the CD4+ count is more than 100 cells/microL, reevaluation rather than immediately initiating therapy may prevent the inadvertent commitment to chronic therapy implicit in a diagnosis of CMV retinitis.