Retinal changes in AIDS

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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212 Retinal changes in AIDS

Instruction

At a distance from the patient, the examiner will say that this patient has HIV, examine his fundus.

Salient features

History

• Floaters

• Red eye

• Impaired vision.

Examination

Patient 1

• Cottonwool spots (Fig. 212.1)

• Tell the examiner that you would like to exclude diabetes and retinal vascular disease.

image

Fig. 212.1 Cotton-wool spots.

Patient 2

• An area of retinitis with nerve fibre layer infarcts, haemorrhages, retinal opacification and perivascular sheathing: ‘pizza-pie fundus’.

• Tell the examiner that you would like to do a CD4 cell count (often <50 × 106 cells/l in when acute cytomegalovirus infection occurs).

Diagnosis

Patient 1 has cotton-wool spots (lesion) and Patient 2 has cytomegalovirus retinitis (lesion). Both patients are HIV positive and infection.

Questions

How would you treat these cotton-wool spots?

In a patient with known HIV infection, such infarcts require no specific therapy.

Advanced-level questions

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