title: HIV and cannot see.
abstract: A 55-year-old HIV-positive man presented with acute vision loss in the right eye and altered mental status. Ophthalmic evaluation revealed light perception vision OD with a right relative afferent pupillary defect, conjunctival chemosis, large mutton-fat keratitic precipitates, and diffuse cream-colored vitreous cells. Magnetic resonance imaging of the brain and orbit with and without contrast with fat saturation showed choroidal thickening OD, multifocal deep periventricular and deep ganglionic enhancing lesions, and a suprasellar mass. Brain biopsy showed diffuse large B-cell lymphoma. Intrathecal chemotherapy with methotrexate and cytarabine and whole brain radiation therapy failed. His mental status deteriorated. He developed pancytopenia, neutropenic fever, and septic shock and subsequently expired under palliative care.
authors.affiliation: Department of Pathology and Genomic Medicine, Ocular Pathology, Houston Methodist Hospital, Houston, TX.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Prospero Ponce
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, TX.
authors.forename: Nagham
authors.initials: N
authors.lastname: Al Zubidi
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, TX; Department of Ophthalmology, Weill Cornell Medical College, Houston, TX.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Beaver
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, TX; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX. Electronic address: AGLee@tmhs.org.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Medical University of South Carolina, Charleston, SC.
authors.forename: Derrick A
authors.initials: DA
authors.lastname: Huey
authors.affiliation: Department of Ophthalmology, Medical University of South Carolina, Charleston, SC.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Chavis
mesh_terms: D001706:Biopsy; D001766:Blindness / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000175:diagnosis*; D015862:Choroid Diseases / Q000175:diagnosis; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011681:Pupil Disorders / Q000175:diagnosis
keywords: CNS lymphoma; HAART; HIV; opportunistic infections; panophthalmitis; uveitis