Lee A K, Chronister C L
Eye Institute, Pennsylvania College of Optometry, Philadelphia, Pennsylvania, USA.
J Am Optom Assoc. 1999 Jun;70(6):384-90.
This is the first ophthalmic report--to our knowledge--of an anterior uveitis secondary to sarcoidosis in a patient infected with human immunodeficiency virus (HIV). Other reported causes of uveitis in HIV-infected patients have included HIV, herpes zoster, tuberculosis, syphilis, toxoplasmosis, cryptococcus, rifabutin prophylaxis for mycobacterium, and protease inhibitors such as ritonavir and indinavir. Uveitis secondary to sarcoidosis in the non-HIV population is classically seen in young, female, African-American patients. There are rare reports, found exclusively in the pulmonary literature, of sarcoidosis in HIV-infected patients.
A 38-year-old African-American male infected with HIV was treated for chronic recurrent anterior uveitis secondary to sarcoidosis. His sarcoidosis was diagnosed 1 month earlier, along with the onset of his uveitis. During the previous 6 years he has been treated with anti-HIV antivirals as well as prophylaxis for opportunistic infections. To date, his infectious disease specialist continues to treat his HIV and systemic sarcoidosis.
Patients with HIV infection in whom sarcoidosis with secondary uveitis develops are very rare. Management of these patients requires careful use of topical and oral steroidal anti-inflammatories to control ocular and systemic sequelae of sarcoidosis. This case initiates some interesting questions about the immunology of sarcoidosis and its presence in immunocompromised patients. Use of steroids in an immunocompromised patient is clinically complex. Further clinical study is needed to elicit the full clinical significance of sarcoidosis and HIV infection.
据我们所知，这是首例关于人类免疫缺陷病毒（HIV）感染患者继发于结节病的前葡萄膜炎的眼科报告。其他报道的HIV感染患者葡萄膜炎的病因包括HIV、带状疱疹、结核病、梅毒、弓形虫病、隐球菌病、预防分枝杆菌的利福布汀以及蛋白酶抑制剂如利托那韦和茚地那韦。非HIV人群中继发于结节病的葡萄膜炎在年轻、女性、非裔美国患者中较为常见。在肺部文献中仅有罕见报道提及HIV感染患者的结节病。
一名38岁感染HIV的非裔美国男性因继发于结节病的慢性复发性前葡萄膜炎接受治疗。他的结节病在1个月前被诊断出来，同时出现了葡萄膜炎。在过去6年里，他一直在接受抗HIV抗病毒药物治疗以及机会性感染的预防治疗。迄今为止，他的传染病专科医生仍在继续治疗他的HIV和系统性结节病。
发生结节病并继发葡萄膜炎的HIV感染患者非常罕见。对这些患者的治疗需要谨慎使用局部和口服甾体类抗炎药来控制结节病的眼部和全身后遗症。该病例引发了一些关于结节病免疫学及其在免疫功能低下患者中存在情况的有趣问题。在免疫功能低下的患者中使用类固醇在临床上较为复杂。需要进一步的临床研究来揭示结节病和HIV感染的全部临床意义。
