Hirschel Tiffany, Steffen Heimo, Pecoul Victor, Calmy Alexandra
Division of Emergencies, Geneva's University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland.
Department of General Medicine, Geneva's University Hospitals and Faculty of Medicine, Geneva, Switzerland.
BMC Res Notes. 2017 Dec 1;10(1):664. doi: 10.1186/s13104-017-2970-5.
Typical symptoms of an acute human immunodeficiency virus (HIV) infections like fever and rash are not specific and can be caused by a multitude of other pathogens, such as Zika or rickettsiosis. Up to 30% of primary HIV infection do not present with the typical flu-like symptoms and thus represent a diagnostic challenge. In this report, we describe a rare case of optic neuropathy as the initial presentation of primary HIV infection, which resulted in irreversible blindness. To our knowledge, only four cases of optic neuropathy resulting from a recent HIV seroconversion have been reported.
In January 2015, a 72-year-old man presented with a rash, fever and diffuse myalgias after returning from a fortnight in Cuba. In the context of the current polemic, Zika was considered likely. A diagnostic work-up, including dengue fever and Zika, was negative. Symptoms resolved spontaneously. In March, the patient experienced a sudden loss of vision first on one, a few days later on the other eye. Magnetic resonance imaging showed optic nerve enhancement suggesting neuritis. Numerous infective causes were sought and the patient was diagnosed with HIV. Corticosteroids and antiretroviral therapy were initiated but vision did not improve. Four weeks later an optic atrophy developed. After more than a year of follow-up the patient remains blind. Stored serum from January revealed a detectable viremia with a negative Western blot assay, typical of acute HIV infection.
Optic neuritis is a rare complication of early HIV infection. Only four others cases have been described, some of which recovered their vision after the administration of corticosteroids and/or ARV treatment. The balance between ischemic and neuroimmune processes may play a role in recovery. Delayed diagnosis, due to an unjustified focus on the Zika virus may have contributed to the tragic outcome.
急性人类免疫缺陷病毒（HIV）感染的典型症状，如发热和皮疹，并不具有特异性，可由多种其他病原体引起，如寨卡病毒或立克次氏体病。高达30%的原发性HIV感染并无典型的流感样症状，因此构成诊断挑战。在本报告中，我们描述了一例罕见的视神经病变作为原发性HIV感染的首发表现，最终导致不可逆性失明。据我们所知，仅有4例因近期HIV血清转化导致视神经病变的病例被报道。
2015年1月，一名72岁男性在从古巴度过两周后出现皮疹、发热和弥漫性肌痛。鉴于当前的争议，寨卡病毒被认为是可能病因。包括登革热和寨卡病毒检测在内的诊断检查均为阴性。症状自行缓解。3月，患者先是一只眼睛突然失明，几天后另一只眼睛也失明。磁共振成像显示视神经强化，提示神经炎。寻找了多种感染病因，患者被诊断为HIV感染。开始使用皮质类固醇和抗逆转录病毒疗法，但视力并未改善。四周后出现视神经萎缩。经过一年多的随访，患者仍然失明。1月份保存的血清显示可检测到病毒血症，免疫印迹试验阴性，这是急性HIV感染的典型表现。
视神经炎是早期HIV感染的一种罕见并发症。仅另有4例被描述，其中一些患者在使用皮质类固醇和/或抗逆转录病毒治疗后恢复了视力。缺血和神经免疫过程之间的平衡可能对恢复起作用。由于不合理地聚焦于寨卡病毒而导致的诊断延迟可能促成了这一悲剧结局。
