title: [Severe case of cytomegalovirus-associated immune reconstitution syndrome in AIDS].
abstract: BACKGROUND
  Immune reconstitution syndrome (IRS) is a complication caused by reactivation of the immune system that can occur after starting highly active antiretroviral therapy (HAART) in patients with acquired immunodeficiency syndrome (AIDS). Severe IRS associated with cytomegalovirus (CMV) in both eyes who had lost his left vision is reported.
  
  
  METHODS
  A 37-year-old man with AIDS who had started HAART discontinued his medication. Two weeks after the re-induction of HAART, he suffered CMV retinitis OU. Vitreous opacity OU appeared 3 days later, and optic neuritis OS appeared 6 days after the onset; and visual acuity OS decreased to 0.06. As the number of CD 4 positive T lymphocytes (CD 4) increased from 39 to 118/microl in both the pre- and- post HAART, we diagnosed IRS and started anti- CMV and systemic steroid therapy and discontinued the HAART. The focus of CMV retinitis was improved; however, visual acuity OS did not improve.
  
  
  CONCLUSIONS
  Severe IRS with visual loss induced by CMV retinitis after HAART needs to be considered in low CD 4 level patients during the induction phase.
authors.affiliation: Department of Ophthalmology, Hospital, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. syashiro@m4.dion.ne.jp
authors.forename: Shigeko
authors.initials: S
authors.lastname: Yashiro
authors.forename: Norio
authors.initials: N
authors.lastname: Takeda
authors.forename: Akihiro
authors.initials: A
authors.lastname: Uemura
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Akiko
authors.initials: A
authors.lastname: Kasagi
authors.forename: Natsuyo
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D000998:Antiviral Agents / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D017726:Cytomegalovirus Retinitis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000077562:Valganciclovir; D014792:Visual Acuity
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir