title: Presumed choroidal atypical tuberculosis superinfected with cytomegalovirus retinitis in an acquired immunodeficiency syndrome patient: a case report.
abstract: BACKGROUND
  To report an unusual case of multifocal choroidopathy with uveitis and cytomegalovirus (CMV) retinitis in a patient with acquired immunodeficiency syndrome (AIDS) after initially presenting with pulmonary tuberculosis (Mycobacterium kansasii).
  
  
  METHODS
  Slit-lamp biomicroscopy and indirect ophthalmoscopic examination were done. Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. Computer tomography scan, magnetic resonance imaging and biopsy of the brain were also carried out.
  
  
  METHODS
  Multiple yellowish-white, round, slightly elevated subretinal pigment epithelium lesions were noted in areas devoid of the atrophic retina of previous CMV infection. Anterior uveitis and vitritis were also noted. Vitreous, retina, and brain biopsy did not offer any clue for diagnosis. The visual acuity improved later, along with recovered immunity under the anti-tuberculosis medications and the cocktail therapy for AIDS.
  
  
  CONCLUSIONS
  Combined CMV retinitis and atypical tuberculosis chorioretinitis, although rare, can develop in the patients with AIDS. Systemic dissemination of atypical tuberculosis infection should be responsible for the choroidopathy in this patient.
authors.affiliation: Department of Ophthalmology, Chang Gang Memorial Hospital, Chang Gang University, Tao-Yuan, Taiwan.
authors.forename: Li-Ju
authors.initials: LJ
authors.lastname: Lai
authors.forename: San-Ni
authors.initials: SN
authors.lastname: Chen
authors.forename: Ya-Hui
authors.initials: YH
authors.lastname: Kuo
authors.forename: Jau-Der
authors.initials: JD
authors.lastname: Ho
authors.forename: Cheng-Lien
authors.initials: CL
authors.lastname: Ho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D015862:Choroid Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D017726:Cytomegalovirus Retinitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D004359:Drug Therapy, Combination; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009165:Mycobacterium Infections, Nontuberculous / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D019909:Mycobacterium kansasii / Q000302:isolation & purification*; D009887:Ophthalmoscopy; D014057:Tomography, X-Ray Computed; D014392:Tuberculosis, Ocular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D014605:Uveitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000995:Antitubercular Agents; D000998:Antiviral Agents