Abstract：
PURPOSE:To describe the ocular presentation of disseminated mycobacterial disease occurring during immune-recovery in a patient with acquired immune deficiency syndrome (AIDS). STUDY DESIGN:Case report and literature review. PARTICIPANTS:A 41-year-old AIDS patient with a prior diagnosis of cytomegalovirus retinitis. METHODS:The patient developed progressive, bilateral multifocal choroiditis with panuveitis 2 months after beginning and responding to highly active antiretroviral therapy. His left eye became blind and painful and was enucleated. Pathologic examination revealed massive choroiditis with well-formed, discrete granulomas and multiple intracellular and extracellular acid-fast organisms within the choroidal granulomas. Culture and polymerase chain reaction of vitreous specimens revealed Mycobacterium avium complex (MAC). RESULTS:Empiric, and later sensitivity-guided, local and systemic antibiotic therapy was used to treat the remaining right eye, but it continued to deteriorate. Despite medical therapy, three vitrectomies and repeated intravitreal injections of amikacin, a total retinal detachment ensued. One week after the third vitrectomy, the patient died from mesenteric artery thrombosis in the setting of disseminated mycobacterial disease. CONCLUSIONS:This is the first report of ocular inflammation as the presenting finding in the recently recognized syndrome of immune-recovery MAC disease. Pathogenesis of this entity is related to an enhanced immune response to a prior, subclinical, disseminated infection. The formation of discrete granulomas, normally absent in MAC infections in AIDS, reflects this mechanism.
journal_name
Ophthalmologyjournal_title
Ophthalmologyauthors
Zamir E,Hudson H,Ober RR,Kumar SK,Wang RC,Read RW,Rao NAdoi
10.1016/s0161-6420(01)01048-xsubject
Has Abstractpub_date
2002-11-01 00:00:00pages
2144-8issue
11eissn
0161-6420issn
1549-4713pii
S0161-6420(01)01048-Xjournal_volume
109pub_type
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