Massive mycobacterial choroiditis during highly active antiretroviral therapy: Another immune-recovery uveitis?

Academic Article

Abstract

  • Purpose: To describe the ocular presentation of disseminated mycobacterial disease occurring during immune-recovery in a patient with acquired immune deficiency syndrome (AIDS). Study design: Case report and literature review. Participants: A 41-year-old AIDS patient with a prior diagnosis of cytomegalovirus retinitis. Methods: The patient developed progressive, bilateral multifocal choroiditis with panuveitis 2 months after beginning and responding to highly active antiretroviral therapy. His left eye became blind and painful and was enucleated. Pathologic examination revealed massive choroiditis with well-formed, discrete granulomas and multiple intracellular and extracellular acid-fast organisms within the choroidal granulomas. Culture and polymerase chain reaction of vitreous specimens revealed Mycobacterium avium complex (MAC). Results: Empiric, and later sensitivity-guided, local and systemic antibiotic therapy was used to treat the remaining right eye, but it continued to deteriorate. Despite medical therapy, three vitrectomies and repeated intravitreal injections of amikacin, a total retinal detachment ensued. One week after the third vitrectomy, the patient died from mesenteric artery thrombosis in the setting of disseminated mycobacterial disease. Conclusions: This is the first report of ocular inflammation as the presenting finding in the recently recognized syndrome of immune-recovery MAC disease. Pathogenesis of this entity is related to an enhanced immune response to a prior, subclinical, disseminated infection. The formation of discrete granulomas, normally absent in MAC infections in AIDS, reflects this mechanism. © 2002 by the American Academy of Ophthalmology, Inc.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Zamir E; Hudson H; Ober RR; Kumar SK; Wang RC; Read RW; Rao NA
  • Start Page

  • 2144
  • End Page

  • 2148
  • Volume

  • 109
  • Issue

  • 11