scholarly journals Immune Recovery Uveitis Masked as an Endogenous Endophthalmitis in a Patient with Active CMV Retinitis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Ligia Figueiredo ◽  
Renata Rothwell ◽  
Miguel Bilhoto ◽  
Rosário Varandas ◽  
Sofia Fonseca
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Endogenous Endophthalmitis ◽  
Immune Recovery ◽  
Blurred Vision ◽  
Positive Polymerase Chain Reaction ◽  
Immune Recovery Uveitis ◽  
Cmv Retinitis ◽  
Highly Active ◽  
Polymerase Chain ◽  
The Right

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.

scholarly journals A presentation of aids-related ophthalmic disease in a severely immunocompromised patient

2010 ◽  
Vol 72 (2) ◽  
pp. 19
Author(s):  
Sally Chetrit
Keyword(s):  
Case Report ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Status ◽  
Opportunistic Infections ◽  
Management Options ◽  
Cmv Retinitis ◽  
Highly Active ◽  
The Right ◽  
Immunodeficiency Syndrome ◽  
Ophthalmic Disease

Background: Human immunodeficiency virus (HIV) retinopathy is the most common ocular manifestation of the acquired immunodeficiency syndrome (AIDS), serving as an important marker for patients with significantly compromised immune status who are at risk for developing severe and visionthreatening ocular opportunistic infections. This case report describes a presentation of HIV retinopathy and cytomegalovirus (CMV) retinitis, and reviews the current management options. Case Report: A 40-year-old black male presented for a comprehensive eye exam to rule out HIV-related ophthalmic disease. At his initial visit, a dilated fundus examination revealed HIV retinopathy of the left eye. Upon subsequent examinations and as his immune status diminished, the patient developed CMV retinitis of the right eye. The patient was treated successfully with a course of highly active antiretroviral therapy (HAART) and oral valgancyclovir.  Conclusion: CMV retinitis is the most common ocular opportunistic infection associated with AIDS. Treatment with systemic HAART and concomitant anti-CMV therapy leads to reconstitution of the immune system and regression of the retinitis.  

Uveitis associated with Immunodeficiency and Drugs; Clinical Findings, Diagnosis, and Treatment

2020 ◽  
pp. 277-283
Keyword(s):  
Anterior Uveitis ◽  
Highly Active Antiretroviral Therapy ◽  
Rare Event ◽  
Clinical Findings ◽  
Diagnosis And Treatment ◽  
Immune Recovery ◽  
Drug Induced ◽  
Cmv Retinitis ◽  
Ocular Manifestations ◽  
Highly Active

Immüne recovery uveitis (IRU) is the most common form of immune reconstitution inflammatory syndrome in human immunodeficiency virus (HIV) infected patients with cytomegalovirus (CMV) retinitis who are receiving highly active antiretroviral therapy (HAART) therapy. In patients with CMV retinitis in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including vitritis, macular edema, epiretinal membrane formation, papillitis, and iris synechiae. Given the range of ocular manifestations of HIV, routine ocular examinations and screening carefully for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. Uveitis has been associated with a number of systemic, intravitreal, and topical medications, and may also occur after vaccination and the use of other substances. However, drug-induced uveitis is a relatively rare event. Only a few drugs have been proven to cause uveitis, whereas many others may not represent a direct cause-and-effect relationship. Anterior uveitis is the most common clinical presentation and therefore, patients with new-onset anterior uveitis should be asked whether they have recently started any new medications. These patients need to undergo the same diagnostic protocol followed for any uveitis case. Drug-induced uveitis is almost always reversible within weeks of cessation of the medication and the institution of topical treatment of the inflammation. The clinical findings, diagnosis, and treatment of IRU and drug-induced uveitis are presented in this current study

scholarly journals Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Beata Urban ◽  
Alina Bakunowicz-Łazarczyk ◽  
Marta Michalczuk
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Visual Loss ◽  
Clinical Symptoms ◽  
Clinical Findings ◽  
Immune Recovery ◽  
Cd4 Counts ◽  
Immune Recovery Uveitis ◽  
Ocular Manifestations ◽  
Highly Active ◽  
Inflammatory Syndrome

IRU is the most common form of immune reconstitution inflammatory syndrome in HIV-infected patients with cytomegalovirus retinitis who are receiving highly active antiretroviral therapy (HAART). Among patients with CMV in the HAART era, immune recovery may be associated with a greater number of inflammatory complications, including macular edema and epiretinal membrane formation. Given the range of ocular manifestations of HIV, routine ocular examinations and screening for visual loss are recommended in patients with CD4 counts <50 cells/μL. With the increasing longevity of these patients due to the use of HAART, treatment of IRU may become an issue in the future. The aim of this paper is to review the current literature concerning immune recovery uveitis. The definition, epidemiology, pathophysiology, clinical findings, complications, diagnosis, and treatment are presented.

scholarly journals Immune recovery vitritis

2007 ◽  
Vol 135 (9-10) ◽  
pp. 513-515 ◽  
Author(s):  
Mirjana Dujic ◽  
Djordje Jevtovic
Keyword(s):  
Opportunistic Infection ◽  
Highly Active Antiretroviral Therapy ◽  
Immune Reconstitution ◽  
Vitreous Body ◽  
The Body ◽  
Immune Recovery ◽  
Cmv Retinitis ◽  
Highly Active ◽  
Dramatic Decline ◽  
Immune Recovery Vitritis

Introduction Immune recovery vitritis (IRV) is symptomatic vitritis of > 1+ severity associated with inactive cytomegalovirus (CMV) retinitis. It is an opportunistic infection of the eye, in the patients who suffer from AIDS, and is treated with a highly active antiretroviral therapy (HAART). As a result of this therapy, there is an immune reconstitution in the body and inflammation of the vitreous body. Objective The aim of the study was to show the incidence of IRV in patients treated with HAART. Method A retrospective study was conducted in patients who suffered from CMV retinitis. Twenty-one were treated with HAART and had the diagnosis of CMV retinitis, as well. All of them were examined by the same ophthalmologist who peformed slit lamp examination with mydriasis and indirect ophthalmoscopy. Results Nine of 21 patients developed IRV as a complication of HAART, two had cystoid macular edema (CMO). Conclusion CMV retinitis develops when the number of CD4+ T lymphocytes drops below 50/mm3. This results in necrotic retinitis which, if untreated, leads to complete loss of vision. With the introduction of HAART, we learned that the reconstitution of immune status was achieved as well as life expectancy, but there was a dramatic decline in the opportunistic infection, including CMV retinitis, as well. With the immune reconstitution, the inflammation develops in the eye, known as IRV. Sometimes, it is necessary to treat this condition, but in the case of our patients, the inflammation was mild, and no treatment was necessary.

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