Lo Phey Feng, Lim Rongxuan, Antonakis Serafeim N, Almeida Goncalo C
Eye Ear and Mouth Unit, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK.
BMJ Case Rep. 2015 May 6;2015:bcr2014207344. doi: 10.1136/bcr-2014-207344.
We present the case of a 54-year-old man who developed progressive outer retinal necrosis (PORN) as an initial manifestation of HIV infection without any significant risk factors for infection with HIV. PORN is usually found as a manifestation of known AIDS late in the disease. Our patient presented with transient visual loss followed by decrease in visual acuity and facial rash. Subsequent investigation revealed anterior chamber tap positive for varicella zoster virus (VZV), as well as HIV positivity, with an initial CD4 count of 48 cells/µL. Systemic and intravitreal antivirals against VZV, and highly active antiretroviral therapy against HIV were started, which halted further progression of retinal necrosis. This case highlights the importance of suspecting PORN where there is a rapidly progressive retinitis, and also testing the patient for HIV, so appropriate treatment can be started.
我们报告了一例54岁男性病例，该患者以进行性外层视网膜坏死（PORN）作为HIV感染的初始表现，且无任何明显的HIV感染危险因素。PORN通常是已知艾滋病晚期的一种表现。我们的患者最初出现短暂视力丧失，随后视力下降并伴有面部皮疹。后续检查发现前房穿刺水痘带状疱疹病毒（VZV）呈阳性，同时HIV检测呈阳性，初始CD4细胞计数为48个/µL。开始使用针对VZV的全身和玻璃体内抗病毒药物，以及针对HIV的高效抗逆转录病毒疗法，这阻止了视网膜坏死的进一步发展。该病例强调了在出现快速进展性视网膜炎时怀疑PORN的重要性，以及对患者进行HIV检测以便能够开始适当治疗 的重要性。
