Recurrent corneal erosion (RCE) secondary to lattice dystrophy in a patient with acquired immune deficiency syndrome (AIDS)

Abstract

We present a case of an Acquired Immune Deficiency Syndrome (AIDS) patient with recurrent erosion (RCE) secondary to lattice corneal dystrophy. As a human immunodeficiency virus (HIV)-infected patient becomes more immunocompromised, the ocular surface defense mechanisms may be compromised. Lattice dystrophy, RCE, and modifying approaches to the management of RCE in an HIV-positive or AIDS patient are reviewed. A 49-year-old man presented with RCE. His ocular history included lattice corneal dystrophy OU, recurrent corneal erosion O.S., and herpes simplex virus keratitis O.S. Systemic history included hepatitis C and HIV infection with a diagnosis of AIDS with secondary Pneumocystis carinii pneumonia. Viral load was 35533 HIV-RNA (ribonucleic acid) molecules/ml of plasma and CD4 lymphocyte count 99 cells/mm3. Acuities were O.D. 20/80 and O.S. 20/50. The abrasion was treated with cycloplegia and bacitracin/polymyxin B ointment q.i.d. O.S. and it resolved in 3 days. Management of lattice dystrophy with secondary RCE in an AIDS patient requires that the clinician be familiar with the patient's immune status. As the CD4 count declines and the viral load increases, the patient is at higher risk for opportunistic anterior segment infections. Clinicians need to monitor these patients closely for potential complicating ocular sequelae of AIDS such as herpes zoster ophthalmicus, herpes simplex keratitis, fungal/bacterial keratitis, and keratoconjunctivitis sicca. Our patient responded well to antibiotic therapy and cycloplegia. The importance of daily monitoring of immunocompromised patients is emphasized.