Bilateral ischemic maculopathy in acquired immune deficiency syndrome

A 26-year-old male with disseminated cryptococcal meningitis, Candida thrush, Pneumocystis jiroveci pneumonia, and positive human immunodeficiency virus (HIV) infection with CD4 count of 4 cells/μl complained of sudden blurred vision in both eyes while on treatment with systemic antiviral, antifungal, and antibiotic medications. Ocular examination revealed HIV retinopathy changes with significant macular ischemia in both eyes, which was confirmed by fluorescein angiography. One dose of intravitreal foscarnet (1.2 mg/0.1 cc) was injected in both eyes. Laboratory work-up of serum and vitreous samples showed negative cytomegalovirus (CMV) titers. At 2 weeks of follow-up, he was started on treatment with atripla, a combination anti-retroviral therapy for AIDS. At 6 weeks of follow-up, there was an improvement in visual acuity and clinical findings.Noninfectious HIV retinopathy in AIDS is common, but bilateral macular ischemia is a rare presentation. It is important to rule out CMV retinitis as it is a major cause of visual morbidity among AIDS patients.Ocular manifestations in AIDS can be visually devastating due to associated infections [1]. In the early stage of human immunodeficiency virus (HIV) infection, noninfectious HIV retinopathy may be a cause of visual compromise [1]. Macular ischemia and edema are rare findings. Few authors reported clinical macular ischemia among AIDS patients [2-5]. We hereby report a case of symmetric bilateral macular ischemia in an AIDS patient. Patient's consent was obtained before all the tests were performed and for the reporting of this case in the medical literature.A 26-year-old Caucasian man was referred to rule out cytomegalovirus (CMV) retinitis after a complaint of blurred vision. He had medical history of Pneumocystis jiroveci pneumonia (PJP), Candida oral thrush, and cryptococcal meningitis 1 month prior to presentation and was on continuing treatment with intravenous ganciclovir (5 mg/kg), fluconazole (800 mg), azithromycin