Su Erin, Lu Jonathan E, Voss Kristina
Department of Ophthalmology, University of Southern California, Los Angeles, California, USA.
Taiwan J Ophthalmol. 2023 Feb 20;13(1):88-92. doi: 10.4103/tjo.TJO-D-22-00130. eCollection 2023 Jan-Mar.
Ocular leishmaniasis, a rare form of vector-borne parasitic infection, can affect the adnexa, retina, uvea, and cornea. Coinfection with human immunodeficiency virus (HIV) and Leishmania may be a distinct clinical entity as the pathogens act synergistically, enhancing each other's pathogenicity, and leading to more severe forms of the disease. Ocular leishmaniasis in the setting of HIV coinfection most commonly causes anterior granulomatous uveitis, for which the etiology can be either active ocular infection or posttreatment inflammatory phenomenon. Keratitis is not considered to be associated with HIV but has rarely been seen from direct parasite invasion or in association with miltefosine. The judicious use of steroids in the treatment of ocular leishmaniasis is critical as steroid use is paramount to the treatment of uveitis associated with posttreatment inflammatory phenomenon but can worsen the prognosis when given in the setting of active, untreated infection. Here, we present a case of unilateral keratouveitis in a leishmaniasis and HIV-coinfected male following completion of systemic antileishmanial therapy. The keratouveitis completely resolved with only the addition of topical steroids. The rapid resolution with steroids suggests that keratitis, not only uveitis, can be an immune-mediated phenomenon in post- or ongoing-treatment individuals.
眼部利什曼病是一种罕见的媒介传播寄生虫感染形式，可累及附属器、视网膜、葡萄膜和角膜。人类免疫缺陷病毒（HIV）与利什曼原虫的合并感染可能是一种独特的临床实体，因为病原体协同作用，增强彼此的致病性，导致更严重的疾病形式。HIV合并感染情况下的眼部利什曼病最常引起前葡萄膜炎，其病因可能是活动性眼部感染或治疗后炎症现象。角膜炎被认为与HIV无关，但很少见于直接的寄生虫侵袭或与米替福新相关的情况。在眼部利什曼病的治疗中明智地使用类固醇至关重要，因为类固醇的使用对于治疗与治疗后炎症现象相关的葡萄膜炎至关重要，但在活动性、未经治疗的感染情况下使用会使预后恶化。在此，我们报告一例在完成全身抗利什曼病治疗后，利什曼病和HIV合并感染男性发生单侧角膜葡萄膜炎的病例。仅加用局部类固醇后，角膜葡萄膜炎完全消退。类固醇的快速消退表明，不仅葡萄膜炎，角膜炎在治疗后或正在治疗的个体中也可能是一种免疫介导的现象。
