Case 8

Chief complaint
A 29-year-old female presented with decreased vision in both eyes (worse in the left) by 3 months. She is also experiencing mild ocular pain, flashing lights, and poor mobility.

History
Past ocular history: No prior ocular diagnosis.
Past medical history: AIDS x 1 year with no prior medical treatment. Recent T-cell count of 4. Unaware of other infections.

Exam

Best corrected visual acuity:	20/60 OD, CF OS
External:	trace injection OU
Slit lamp:	A/C 1+ cells, 3+ flare (immune system down, so fewer cells); fine KPs (hard to see) [view video 1] [view video 2]
IOPs (applanation tonometry):	8mmHg OU
Dilated fundus exam (DFE):	OD OD OS bilateral severe CMV retinitis

Assessment: Extensive cytomegalovirus retinitis (CMVR) bilaterally (entire retina and macula OS; macula spared OD) secondary to AIDS. At risk for retinal detachment OU.

Plan/Treatment

Patient's family has no money. She is from Thailand and not a US citizen, so does not qualify for humanitarian care.

• Referral for anti-CMVR treatment ASAP.
• Referral for AIDS treatment.
• Follow-up:

  2 weeks started on Valcyte 900 mg bid PO, Cambivir and Sustiva PO. Best corrected visual acuities were 20/100 OD, LP OS. CMVR had progressed to involve macula OD. Retinal detachment inferior temporal quadrant OD.

  OD

  OS