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Clinical microbiological case: visual problems in an HIV-positive patient
CONTINUING MEDICAL EDUCATION
Clinical microbiological case: visual problems in an HIV-positive patient S. Lightman1,2 and W. A. Lynn1 1
Institute of Ophthalmology/Moorfields Eye Hospital and 2Ealing Hospital, London, UK
Accepted 29 June 2001
C A S E R E P OR T A 36-year-old HIV-positive male reported a sudden onset of floaters in his left eye, having had no previous ocular problems. He was originally from Morocco, and presented with molluscum contagiosum 8 years earlier, at which time his CD4 count was 320 cells/mL. Over the next few years, his CD4 count gradually dropped to 30 cells/mL, and HIV viral load rose to 160 000 copies/mL. Infectious complications included pulmonary tuberculosis, refractory oral candidiasis and genital herpes. He took primaquine 15 mg/day as prophylaxis for Pneumocystis carinii, and in early 1997 finally decided to start combination antiretroviral therapy (HAART) with stavudine, lamivudine and nelfinavir. Compliance was variable, and at the time of presentation with his eye problem his CD4 count had risen to 80 cells/mL, with an HIV viral load of <400 copies/mL. On examination, his left eye was slightly injected, and vision was 6/9, with cells in the anterior chamber and more in the vitreous. In the retina, there was a patch of retinitis temporal to the macula (Figure 1). No scars were seen. The right eye was normal. A diagnostic procedure was performed.
Figure 1
Q UE S T ION S 1. What is the most likely diagnosis of his eye problem? 2. What is the differential diagnosis?
3. What was the diagnostic procedure? 4. What is the next investigation that needs to be done?
Corresponding author and reprint requests: S. Lightman, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK Tel: þ44 20 75662266 Fax: þ44 20 72519350 E-mail: [email protected]
ß 2001 Copyright by the European Society of Clinical Microbiology and Infectious Diseases
Clinical microbiological case: visual problems in an HIV-positive patient S. Lightman1,2 and W. A. Lynn1 1
Institute of Ophthalmology/Moorfields Eye Hospital and 2Ealing Hospital, London, UK
Accepted 29 June 2001
C A S E R E P OR T A 36-year-old HIV-positive male reported a sudden onset of floaters in his left eye, having had no previous ocular problems. He was originally from Morocco, and presented with molluscum contagiosum 8 years earlier, at which time his CD4 count was 320 cells/mL. Over the next few years, his CD4 count gradually dropped to 30 cells/mL, and HIV viral load rose to 160 000 copies/mL. Infectious complications included pulmonary tuberculosis, refractory oral candidiasis and genital herpes. He took primaquine 15 mg/day as prophylaxis for Pneumocystis carinii, and in early 1997 finally decided to start combination antiretroviral therapy (HAART) with stavudine, lamivudine and nelfinavir. Compliance was variable, and at the time of presentation with his eye problem his CD4 count had risen to 80 cells/mL, with an HIV viral load of <400 copies/mL. On examination, his left eye was slightly injected, and vision was 6/9, with cells in the anterior chamber and more in the vitreous. In the retina, there was a patch of retinitis temporal to the macula (Figure 1). No scars were seen. The right eye was normal. A diagnostic procedure was performed.
Figure 1
Q UE S T ION S 1. What is the most likely diagnosis of his eye problem? 2. What is the differential diagnosis?
3. What was the diagnostic procedure? 4. What is the next investigation that needs to be done?
Corresponding author and reprint requests: S. Lightman, Institute of Ophthalmology, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK Tel: þ44 20 75662266 Fax: þ44 20 72519350 E-mail: [email protected]
ß 2001 Copyright by the European Society of Clinical Microbiology and Infectious Diseases