Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2019  |  Volume : 67  |  Issue : 1  |  Page : 116--117

Simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts


Rama Rajagopal1, Pratik V Kataria1, Sudharshan Sridharan1, Krishna Kumar1, Kuzhanthai Lily Therese1, Poongulali Selvamuthu2,  
1 Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
2 YRG Medical Education and Research Foundation, Rajiv Gandhi Salai, Taramani, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Rama Rajagopal
Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai - 600 006, Tamil Nadu
India

Abstract




How to cite this article:
Rajagopal R, Kataria PV, Sridharan S, Kumar K, Therese KL, Selvamuthu P. Simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts.Indian J Ophthalmol 2019;67:116-117


How to cite this URL:
Rajagopal R, Kataria PV, Sridharan S, Kumar K, Therese KL, Selvamuthu P. Simultaneous presentation of ocular surface squamous neoplasia with viral retinitis in HIV-positive patients with low CD4 counts. Indian J Ophthalmol [serial online] 2019 [cited 2024 Mar 29 ];67:116-117
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2019/67/1/116/248178


Full Text

Ocular manifestations of human immunodeficiency virus (HIV) are common, even in the era of highly active antiretroviral therapy (HAART).[1]

 Case Reports



Case 1

A 36-year-old HIV-positive male, on HAART with CD4 count of 160 cells/mm3, presented with an inferonasal raised opalescent corneal limbal mass (3 × 1 mm) with fimbriated edges in the left eye [Figure 1]. Fundus examination in the left eye showed vitritis, multiple retinal haemorrhages and necrotising retinitis [Figure 2], clinically suggestive of acute retinal necrosis (viral retnitis).{Figure 1}{Figure 2}

Serology was positive for syphilis, whereas polymerase chain reaction (PCR) test on aqueous was positive for varicella-zoster virus (VZV). Patient was treated with intravenous acyclovir followed by oral valacyclovir and anti-syphilitic treatment. Excisional biopsy of the ocular surface lesion was performed showing conjunctival epithelial dysplasia.

Case 2

A 41-year-old HIV-positive male, on HAART with CD4 count of 192 cells/mm3, presented with an inferonasal raised gelatinous limbal mass (7 × 5 mm) with prominent feeder vessels [Figure 3]. Fundus examination in both eyes revealed mild vitritis, retinal vasculitis and granular retinitis [Figure 4], clinically suggestive of active granular cytomegalovirus retinitis.{Figure 3}{Figure 4}

PCR test on aqueous was inconclusive. Patient was treated with oral valgancyclovir. Excisional biopsy of the ocular surface lesion was performed showing conjunctival epithelial dysplasia [Figure 5].{Figure 5}

 Discussion



Ocular manifestations of HIV include HIV retinopathy, viral retinitis, opportunistic infections, and ocular malignancies.[2]

HIV is a known risk factor for ocular surface squamous neoplasia (OSSN)[3] Most common posterior segment manifestation is viral retinitis caused by human herpesvirus family.[4],[5]

Isolated anterior and posterior segment manifestations of HIV are common. Medline search did not report any simultaneous occurrence of OSSN with viral retinitis in HIV.

 Conclusion



Ocular manifestations of HIV may rarely have simultaneous anterior and posterior segment involvement, especially with low CD4 counts. Comprehensive evaluation leading to early diagnosis and management may limit vision-threatening complications.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Biswas J, Madhavan HN, George AE, Kumarasamy N, Solomon S. Ocular lesions associated with HIV infection in India: A series of 100 consecutive patients evaluated at a referral center. Am J Ophthalmol 2000;129:9-15.
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4Banker AS. Posterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome. Indian J Ohthalmol 2008;56:377-83.
5Schulman JA, Peyman GA. Management of viral retinitis. Ophthalmic Surg 1988;19:876-84.