%0 Journal Article
%T Immune Recovery Uveitis Masked as an Endogenous Endophthalmitis in a Patient with Active CMV Retinitis
%A Ligia Figueiredo
%A Renata Rothwell
%A Miguel Bilhoto
%A Ros¨¢rio Varandas
%A Sofia Fonseca
%J Case Reports in Ophthalmological Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/462968
%X 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. 1. Introduction 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¨C4]. Vitritis when present is usually mild and minimally symptomatic due to the severe immunodeficiency always associated with AIDS [1, 5]. 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¨C9]. We herein report a case of severe IRU with active CMV retinitis in a 40-year-old male infected with human immunodeficiency virus (HIV) and no known previous ophthalmological examination. When HAART was initiated, he developed signs of severe intraocular inflammation with panuveitis and hypopyon. 2. Case-Report A 40-year-old male presented with progressive visual loss, floaters, pain, and redness in the right eye for a week, with no other systemic complaints. He had been diagnosed with HIV-1 infection in 2010 and was being treated with abacavir, lamivudine, and efavirenz for six months (from March until August of 2012), but, due to low therapy
%U http://www.hindawi.com/journals/criopm/2013/462968/