Pneumocystis carinii choroiditis in patients with AIDS: clinical features, response to therapy, and outcome.
To further characterize the clinical features, response to therapy, and outcome of Pneumocystis carinii choroiditis in patients with AIDS, we retrospectively reviewed the course of choroiditis for eight patients identified from two institutions through April 1991. Seven patients had prior Pneumocystis carinii pneumonia and had received aerosolized pentamidine prophylaxis for a median of 10 months; one patient had no prior history of pneumonia or prophylaxis. The median CD4+ lymphocyte count for six patients was 11 cells/mm3. Choroiditis was a preterminal diagnosis for three patients--two with associated disseminated pneumocystosis. Ocular manifestations improved or resolved with therapy for five of the six treated patients. All five subsequently received prophylaxis with dapsone (n = 2), dapsone/trimethoprim (n = 2), or aerosolized pentamidine (n = 1). Choroiditis recurred at 15 months in the one patient receiving aerosolized pentamidine. The median survival from time of diagnosis was 44 weeks. A literature review including an additional 40 cases support the conclusions that (a) Pneumocystis choroiditis is a rare complication of advanced HIV disease, occurring often in the context of systemic pneumocystosis; (b) ocular signs and symptoms may improve or resolve with specific antipneumocystis therapy; and (c) relapse may occur, particularly in those not receiving systemic prophylaxis.
Sha
B E
BE
Department of Medicine, Rush Medical College/Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612.
Benson
C A
CA
Deutsch
T
T
Noskin
G A
GA
Murphy
R L
RL
Pottage
J C
JC
Finn
W G
WG
Roth
S I
SI
Kessler
H A
HA
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D000328:Adult; D002833:Choroiditis / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D005123:Eye / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D010419:Pentamidine / Q000627:therapeutic use*; D011010:Pneumocystis / Q000302:isolation & purification; D016720:Pneumocystis Infections / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
D010419:Pentamidine