1/11. Diffuse toxoplasmic retinochoroiditis as the initial manifestation of acquired immunodeficiency syndrome.Toxoplasmic retinochoroiditis is an important opportunistic retinal infection in human immunodeficiency virus (hiv)-infected patients. It may present as diffuse necrotizing retinochoroiditis instead of a focal lesion and may be the initial manifestation of hiv infection. A 50-year-old heterosexual man presented with blurred vision in his left eye of 3 months' duration. Fundus examination revealed diffuse necrotizing retinochoroiditis, mainly at the posterior pole, with marked vitritis in the left eye. Serologic studies and aqueous fluid antibody titers indicated recent toxoplasmic infection. Positive enzyme immunoassays (EIA) and Western blot tests proved hiv infection. The retinochoroiditis and vitritis improved after an antitoxoplasmic regimen with trimethoprim-sulfamethoxazole (TMP-SMX). Nonetheless, toxoplasmic encephalitis developed 6 months after the onset of ocular toxoplasmosis and responded well to TMP-SMX. This is the first case of toxoplasmic retinochoroiditis as the initial manifestation of AIDS reported in taiwan. We suggest that toxoplasma infection should be included in the differential diagnosis of diffuse necrotizing retinochoroiditis and vitritis. We also recommend that adults with newly diagnosed ocular toxoplasmosis be screened for hiv infection.- - - - - - - - - - ranking = 1keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
2/11. Otic and ophthalmic pneumocystosis in acquired immunodeficiency syndrome. Report of a case and review of the literature.A case of primary pneumocystis carinii infection involving the left middle ear of a patient with acquired immunodeficiency syndrome is described, and the literature on the otic and ophthalmic pneumocystosis is reviewed. Otic pneumocystosis typically presents as a unilateral polypoid mass, and it is clinically manifested as otalgia, hearing loss, or, sometimes, otorrhea without evidence of current respiratory disease or previous Pneumocystis pneumonia. In contrast, choroidal pneumocystosis usually occurs in a patient with acquired immunodeficiency syndrome with at least one previous episode of Pneumocystis pneumonia and aerosolized pentamidine treatment, it is usually asymptomatic and bilateral, and it may be discovered only because of other concurrent human immunodeficiency virus-related ophthalmic disease. The diagnosis is made clinically, and intravenous antiparasite treatment is successful.- - - - - - - - - - ranking = 1.4909525336039keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
3/11. Discontinuation of highly active antiretroviral therapy leads to cryptococcal meningitis/choroiditis in an AIDS patient.BACKGROUND: cryptococcus neoformans is an opportunistic pathogen that can manifest in immunocompromised patients with acquired immune deficiency syndrome. Prevention of cryptococcosis and other opportunistic diseases is an objective in the management of human immunodeficiency virus (hiv)-infected patients. The goal of highly active antiretroviral therapy (HAART) is to reduce the viral loads and enhance CD4 counts in hiv-infected patients. These 2 mechanisms keep hiv-infected patients healthier and enhance their immune systems, thus reducing and often preventing opportunistic infections such as ocular cryptococcal infections. Discontinuation of HAART can lead to ocular opportunistic infections such as cryptococcal choroiditis. CASE REPORT: Presented here is a case of a patient who was treated successfully with HAART of stavudine (D4T), abacavir (Ziagen), ritonavir (Norvir), and saquinavir (Invirase). His last CD4 count before HAART was discontinued was 131 cells/mm(3), and viral load was less than 50 copies/mL. He discontinued his HAART regimen for 2 years and presented to the emergency room with complaints of a severe headache with neck pain, lightheadedness, nausea, disorientation, and unsteady gait. Lumbar puncture results showed cryptococcal infection, and the patient was admitted for the treatment of cryptococcal meningitis with amphotericin b and 5-flucytosine. Cryptococcal choroiditis was diagnosed after treatment of the meningitis. After resolution, his resultant visual acuities were 10/350 in the right eye and 10/600 in the left eye. He is on a maintenance dose of antifungal therapy and has been reinitiated on HAART of abacavir/zidovudine/lamivudine (Trizivir) and lopinavir/ritonavir (Kaletra). CONCLUSION: This case exemplifies the importance of HAART in the prevention of opportunistic infections, cryptococcal meningitis/choroiditis in particular. eye care professionals can play a role in encouraging patients to comply with their HAART regimens.- - - - - - - - - - ranking = 0.018094932792101keywords = immunodeficiency (Clic here for more details about this article) |
4/11. role of chorioretinal biopsy in inflammatory eye disease.Two patients who had similar clinical presentations of bilateral multiple chorioretinal lesions and needed a correct diagnosis underwent chorioretinal biopsy. The biopsy from one patient demonstrated mainly a B cell infiltrate in choroidal and subretinal nodules, while the biopsy from the second patient showed mainly macrophages in the retina. These findings directed the therapeutic approach taken in each patient. Although chorioretinal biopsy is an invasive procedure with the potential for serious complications, the resultant finding may aid in the diagnosis and guide the subsequent management of certain patients presenting with serious ocular findings of undefined etiology.- - - - - - - - - - ranking = 0.00093446341221534keywords = aid (Clic here for more details about this article) |
5/11. Extrapulmonary pneumocystosis: clinical features in human immunodeficiency virus infection.pneumocystis carinii infection is reported with increasing frequency as a cause of disease outside of the respiratory tract in patients with human immunodeficiency virus (hiv) infection. Extrapulmonary pneumocystosis is not limited to patients in any discrete risk group for hiv infection. patients with hiv infection who develop extrapulmonary pneumocystosis frequently do not have concurrent P. carinii pneumonia. signs and symptoms of extrapulmonary pneumocystosis are nonspecific but when present are frequently referable to the tissues or organs involved. Extrapulmonary pneumocystosis can be diagnosed by examination of tissue biopsies from affected sites using standard histologic techniques. Therapy with antimicrobial agents used to treat P. carinii pneumonia has been effective in some patients. An association between use of aerosolized pentamidine for prevention of P. carinii pneumonia and development of extrapulmonary pneumocystosis has been suggested but remains unconfirmed. Other factors such as the use of zidovudine and duration of immunodeficiency may also be important to the pathogenesis of extrapulmonary pneumocystosis. Further studies are needed to better identify risk factors that may predispose patients to the development of extrapulmonary pneumocystosis.- - - - - - - - - - ranking = 0.1085695967526keywords = immunodeficiency (Clic here for more details about this article) |
6/11. pneumocystis carinii choroiditis after long-term aerosolized pentamidine therapy.pneumocystis carinii pneumonia is a major cause of morbidity and mortality in patients with the acquired immunodeficiency syndrome. When P. carinii is disseminated, the choroid may be involved and the infection is often fatal. We examined, treated, and followed up two patients who developed choroidal lesions typical of P. carinii while taking aerosolized pentamidine for prophylaxis. The choroidal lesions gradually resolved after three weeks of therapy with intravenous trimethoprim and sulfamethoxazole in one patient, and after three weeks of therapy with parenteral pentamidine in the other patient. The patients did not have clinical or laboratory evidence of P. carinii infection other than in the eye. It thus appears that early ophthalmologic examination may detect disease before it is threatening to sight and allow systemic therapy to be instituted before widely disseminated infection results in a fatal outcome.- - - - - - - - - - ranking = 0.24547626680197keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
7/11. A clinical, histopathologic, and electron microscopic study of pneumocystis carinii choroiditis.We studied the clinical and histopathologic features of pneumocystis carinii choroiditis in three patients with acquired immunodeficiency syndrome. In two cases, a provisional diagnosis of disseminated P. carinii infection was made by ophthalmologic examination. The characteristic fundus changes in this infection consisted of numerous slightly elevated, plaque-like, yellow-white lesions located in the choroid and unassociated with signs of intraocular inflammation. The diagnosis was confirmed by postmortem examination of the eyes and other organs. Histopathologically, the globes showed many choroidal infiltrates that were eosinophilic, acellular, vacuolated, and frothy. Several such infiltrates were noted within the choroidal vessels and choriocapillaries. Gomori's methenamine silver stain demonstrated many cystic and crescentic organisms. Electron microscopy disclosed thick-walled cystic organisms and large numbers of trophozoites.- - - - - - - - - - ranking = 0.24547626680197keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
8/11. Unilateral cytomegalovirus retinochoroiditis and bilateral cytoid bodies in a bisexual man with the acquired immunodeficiency syndrome.A 42-year-old bisexual man with the acquired immunodeficiency syndrome, cryptococcal meningitis, disseminated mycobacterium avium-intracellulare with mycobacteremia, and oropharyngeal candidiasis developed unilateral retinitis and bilateral cotton wool patches. Histopathologic examination revealed unilateral necrotizing retinochoroiditis with virions in retinal and choroidal tissues. Postmortem cultures of retina and choroid were positive for cytomegalovirus.- - - - - - - - - - ranking = 1.2273813340099keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
9/11. Limbal and choroidal Cryptococcus infection in the acquired immunodeficiency syndrome.PURPOSE: A 30-year-old patient with the acquired immunodeficiency syndrome (AIDS) had limbal nodules and multifocal choroidal lesions. methods: A biopsy of the limbal nodules was performed. RESULTS: The biopsy showed cryptococcus neoformans surrounded by thick mucinous capsules without inflammatory cell infiltration. CONCLUSION: In the differential diagnosis of limbal mass in patients with AIDS, cryptococcal infection should be considered.- - - - - - - - - - ranking = 1.2273813340099keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
10/11. Tuberculous choroiditis and acquired immunodeficiency syndrome.tuberculosis is a common illness among patients with acquired immunodeficiency syndrome (AIDS), and therefore, choroidal tubercles are expected to be found in these patients. Nevertheless, this association (AIDS-induced choroidal tuberculosis) is infrequently reported in the literature. We report four cases of patients with AIDS and tuberculosis who did not have any visual complaints and in whom a routine funduscopic examination disclosed the presence of choroidal nodules. These lesions were not accompanied by vitritis, iridocyclitis, or any sign of uveitis as has been reported in cases of tuberculous choroiditis in patients with AIDS by others in the literature.- - - - - - - - - - ranking = 1.2273813340099keywords = immunodeficiency syndrome, immunodeficiency (Clic here for more details about this article) |
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