1
|
Bonnet LA, Evans KF. CMV neuroretinitis in a post-transplant patient. BMJ Case Rep 2023; 16:e255639. [PMID: 38061847 PMCID: PMC10711889 DOI: 10.1136/bcr-2023-255639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
This report presents an atypical case of neuroretinitis in a post-transplant patient. A man in his 40s presented to a provincial ophthalmology service with unilateral left visual loss. He was immunosuppressed following orthotopic liver transplantation for end-stage liver cirrhosis secondary to primary sclerosing cholangitis. He had received his third Pfizer-BioNTech COVID-19 booster vaccine 34 days prior to symptom onset. His presenting left visual acuity was 6/36. His left optic nerve head was grossly swollen with peripapillary haemorrhage, intraretinal and subretinal fluid extending to involve the fovea. His serological and radiological investigations were all negative except for serum IgG and IgM positivity to cytomegalovirus (CMV). Following the commencement of antiviral treatment and systemic steroids, his neuroretinitis improved with visual recovery to 6/4.5. This report describes an atypical presentation of neuroretinitis in an immunocompromised patient without AIDS but with evidence of CMV exposure.
Collapse
Affiliation(s)
- Louis Antoine Bonnet
- Department of Ophthalmology, University of Otago - Dunedin Campus, Dunedin, New Zealand
- Department of Ophthalmology, Southern District Health Board, Dunedin, Otago, New Zealand
| | - Kay Frances Evans
- Ophthalmology Department, Palmerston North Hospital, Palmerston North, New Zealand
| |
Collapse
|
2
|
Cobaschi M, Loghin II, Dorobăț VD, Silvaș G, Rusu ȘA, Hârtie V, Aramă V. Ophthalmological Manifestations in People with HIV from Northeastern Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1605. [PMID: 37763724 PMCID: PMC10536229 DOI: 10.3390/medicina59091605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Although ocular disorders can occasionally impact people with HIV over the course of their illness, HIV/AIDS is unmistakably a multisystem disorder. A physician can rule out a wide range of ophthalmic problems with the assistance of an ophthalmologist, from adnexal disorders to posterior segment diseases, including those affecting the optic tract and optic nerve. Materials and Methods: Based on patient medical data from the "St. Parascheva" Clinical Hospital of Infectious Diseases in Iasi, we carried out a retrospective clinical investigation on patients with HIV/AIDS and ophthalmological conditions who were hospitalized in northeastern Romania. We seek to draw attention to the characteristics and ophthalmological comorbidities of HIV/AIDS patients. The studied period was between 1 January 1991 and 31 December 2022. Results: There were a total of 38 recorded cases of ophthalmological manifestations in the HIV-infected patients. The research group's average age was 37.31 years old (standard deviation 9.5693917). Males were primarily impacted, having lower total CD4+ T-lymphocyte levels based on sex and CD4+ T-lymphocyte levels overall. The HIV viral load was 999 268.13 copies/mL on average (standard deviation 1,653,722.9). Of all the patients, we found out that 17 had congenital eye diseases (44.73%) and the others (21, 55.26%) developed ophthalmological diseases. CMV Retinitis was found most frequently, in eight patients (21.05%), followed by Myopia in seven patients (18.42%). Conclusions: The key to the management of HIV-positive patients is a multidisciplinary approach and access to antiretroviral therapy. Anyone who is HIV-positive and experiences ocular symptoms at any time should be directed to seek professional ophthalmologic treatment as soon as feasible. A therapeutic holdup could result in irreversible vision loss. Long-term coordination is required to combat this disease, improving communication between the ophthalmology and infectious disease fields.
Collapse
Affiliation(s)
- Mihaela Cobaschi
- Faculty of Medicine/Clinical II Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
| | - Isabela Ioana Loghin
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Victor Daniel Dorobăț
- Faculty of Medicine/Clinical II Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Intensive Care, University Hospital of Emergency, 050098 Bucharest, Romania
| | - George Silvaș
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Șerban Alin Rusu
- Department of Infectious Diseases, "St. Parascheva" Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania
| | - Vlad Hârtie
- Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Intensive Care, Clinical Hospital of Emergency "Prof. Dr. Nicolae Oblu", 700309 Iasi, Romania
| | - Victoria Aramă
- Faculty of Medicine/Clinical II Department, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- National Institute for Infectious Diseases "Prof. Dr. Matei Balș", 021105 Bucharest, Romania
| |
Collapse
|