Presumed choroidal atypical tuberculosis superinfected with cytomegalovirus retinitis in an acquired immunodeficiency syndrome patient: a case report.
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.
Lai
Li-Ju
LJ
Department of Ophthalmology, Chang Gang Memorial Hospital, Chang Gang University, Tao-Yuan, Taiwan.
Chen
San-Ni
SN
Kuo
Ya-Hui
YH
Ho
Jau-Der
JD
Ho
Cheng-Lien
CL
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
D000995:Antitubercular Agents; D000998:Antiviral Agents