Atypical Manifestation of Progressive Outer Retinal Necrosis in AIDS Patient with CD4+ T-Cell Counts More Than 100 Cells/μL on Highly Active Antiretroviral Therapy
Pornpattana Vichitvejpaisal MD*, Somporn Reeponmahar MD*, Woraphot Tantisiriwat MD**
Affiliation : * Department of Ophthalmology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ** Department of Preventive and Social Medicine, Faculty of Medicine, Srinakahrinwirot University, Nakhon-nayok, Thailand
Typical progressive outer retinal necrosis (PORN) is an acute ocular infectious disease in acquired immunodeficiency syndrome (AIDS) patients with extremely low CD4+ T-cell counts. It is a form of the Varicella- zoster virus (VZV) infection. This destructive infection has an extremely rapid course that may lead to blindness in affected eyes within days or weeks. Attempts at its treatment have had limited success. We describe the case of a bilateral PORN in an AIDS patient with an initial CD4+ T-cell count >100 cells/μL that developed after initiation of highly active antiretroviral therapy (HAART). A 29-year-old Thai female initially diagnosed with human immunodeficiency virus (HIV) in 1998, presented with bilaterally decreased visual acuity after initiating HAART two months earlier. Multiple yellowish spots appeared in the deep retina without evidence of intraocular inflammation or retinal vasculitis. Her CD4+ T-cell count was 127 cells/μL. She was diagnosed as having PORN based on clinical features and positive VZV in the aqueous humor and vitreous by polymerase chain reaction (PCR). Despite combined treatment with intravenous acyclovir and intravitreous ganciclovir, the patient’s visual acuity worsened with no light-perception in either eye. This case suggests that PORN should be included in the differential diagnosis of reduced visual acuity in AIDS patients initiating HAART with higher CD4+ T-cell counts. PORN may be a manifestation of the immune reconstitution syndrome.
Keywords : Progressive outer retinal necrosis, Varicella-zoster virus, Acquired immunodeficiency syndrome, Highly active antiretroviral therapy
