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LETTER TO EDITOR
Year : 2004  |  Volume : 52  |  Issue : 4  |  Page : 340-1

Massive peripapillary retinal haemorrahge in a case of acquired immunodeficiency syndrome.



Correspondence Address:
M Varghese


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PMID: 15693334

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How to cite this article:
Varghese M, Singh S, Gopal SK. Massive peripapillary retinal haemorrahge in a case of acquired immunodeficiency syndrome. Indian J Ophthalmol 2004;52:340

How to cite this URL:
Varghese M, Singh S, Gopal SK. Massive peripapillary retinal haemorrahge in a case of acquired immunodeficiency syndrome. Indian J Ophthalmol [serial online] 2004 [cited 2020 Jun 3];52:340. Available from: http://www.ijo.in/text.asp?2004/52/4/340/14553

Dear Editor,

India is rapidly emerging as the epicenter of Acquired Immunodeficiency Syndrome (AIDS). The ocular manifestations occur in 40 to 70% of AIDS patients[1] and hence the role of the ophthalmologist is becoming increasingly important in evaluation of AIDS patients.

Neuro-ophthalmic complications are known to occur in 10-15% of AIDS patients[1] and papilloedema is described as the most frequent ocular sign of intra-cranial involvement.[2] We report an unusual case of massive peripapillary retinal haemorrhage in an AIDS patient with cryptococcal meningitis.

A 33-year-old male truck driver was referred from the medicine department with a history of blurred vision in his right eye of a week's duration. He had earlier been tested positive for Human Immunodeficiency Virus (HIV 1) infection. There was a history of treatment for bilateral suppurative otits media, cryptococcal meningitis and tuberculosis in the previous 4 years. He was again treated for cryptococcal meningitis one month prior to the present symptoms. The diagnosis of cryptococcal meningitis was based on the cerebrospinal fluid findings.

On examination the visual acuity was counting fingers at 2 metres in the right eye and 6/6 p in the left eye. Anterior segment was normal in both eyes. Fundus examination showed dense peripapillary retinal haemorrhage in both eyes with subhyaloid haemorrhage in the macular area of the right eye [Figure - 1] and [Figure - 2]. The visual acuity remained the same at the end of one month but fundus examination showed considerable reduction in both peripapillary and subhyaloid haemorrhages. On examination after 3 months the visual acuity was 6/36 in the right eye and 6/6 in the left eye and fundus examination revealed normal discs in both eyes with a few juxta-papillary haemorrhages. There was evidence of resolved oedema with retinal pigment epithelial changes in the right macula, and the left macula was normal. Patient compliance was very poor throughout the illness. We were informed of his death within a few months.

More than 50% of neuro-ophthalmic presentations are due to cryptococcal meningitis.[1] It is caused by Cryptococcus neoformans , the most common life- threatening fungal pathogen that infects patients with AIDS. Cryptococcal meningitis with optic nerve involvement may manifest as acute visual loss, which may be bilateral.

Kestelyn and Taelman described papilloedema as the most frequent ocular sign (31%) in AIDS.[2] Although papilloedema with few peri-papillary and retinal haemorrhages has been reported, there is no known documentation of such dense peripapillary retinal haemorrhage as seen in this case. Papilloedema is related to raised intracranial pressure, which has been shown to exist in a majority of patients with AIDS with cryptococcal meningitis. The visual loss may be due to involvement of the optic nerve, tract or the chiasma. Cryptococcal infection in HIV positive patients is often characterised by a lack of inflammatory response and relapses are common in absence of longterm suppressive therapy.[2] Sudden appearance of massive peripapillary retinal haemorrhage one month after being treated for cryptococcal meningitis is unusual. To our knowledge, this is a rare instance of massive peripapillary retinal haemorrhage in a patient who had cryptococcal meningitis.



 
  References Top

1.
Biswas J, Agarwal M. Diagnosis and management of ocular manifestations of AIDS. Karnataka J of Ophthalmol 2003;20:5-13.  Back to cited text no. 1
    
2.
Kestlyn P, Taelman H, Bogaerts J, Kagame A, Aziz MA, Batungwanayo J, et al. Ophthalmic manifestations of infections with cryptococcus neoformans in patients with acquired immune deficiency syndrome. Am J Ophthalmol 1993;116:721-27.  Back to cited text no. 2
    


    Figures

  [Figure - 1], [Figure - 2]


This article has been cited by
1 Ophthalmic manifestations of immune reconstitution inflammatory syndrome associated with Cryptococcus neoformans
Khurana, R.N., Javaheri, M., Rao, N.
Ocular Immunology and Inflammation. 2008; 16(4): 185-190
[Pubmed]



 

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