Evaluation and Management of Uveitis in a Patient With AIDS With Low CD4 Count and Prior CMV Retinitis.

Abstract

Purpose: To report an unusual case of uveitis in a patient with AIDS with low CD4 count. Methods: A single case was evaluated. Results: A 28-year-old man with AIDS, central nervous system lymphoma, and cytomegalovirus (CMV) viremia developed subacute vitritis in the left eye. He endorsed 1 month of blurry vision 2 years after initiating antiretroviral therapy. Current CD4 count was 40 cells/mm³ and HIV viral load was undetectable. He received empiric intravenous antiviral therapy and declined intravitreal injections. Due to worsening clinical course, diagnostic and therapeutic vitrectomy was performed, and intraoperative examination was consistent with prior CMV infection. Aqueous polymerase chain reaction (PCR) was positive for CMV. Infectious workup was otherwise unremarkable. Vitreous cytology and flow cytometry were negative for vitreoretinal lymphoma. Conclusions: Immune recovery uveitis from CMV retinitis should be included in the differential for subacute vitritis in a patient with AIDS and low (<50) CD4 count on antiretroviral therapy.