艾滋病合并低CD4计数及既往巨细胞病毒性视网膜炎患者葡萄膜炎的评估与管理
Evaluation and Management of Uveitis in a Patient With AIDS With Low CD4 Count and Prior CMV Retinitis.
作者信息
Song Weilin, Margines Jack Benjamin, Qaseem Yaqoob, Au Adrian, Sridhar Jayanth
机构信息
Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA.
Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA.
出版信息
J Vitreoretin Dis. 2025 Aug 30:24741264251366408. doi: 10.1177/24741264251366408.
To report an unusual case of uveitis in a patient with AIDS with low CD4 count. A single case was evaluated. 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/mm 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. 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.
报告一例艾滋病患者CD4计数低时发生葡萄膜炎的罕见病例。对单个病例进行了评估。一名患有艾滋病、中枢神经系统淋巴瘤和巨细胞病毒（CMV）病毒血症的28岁男性左眼出现亚急性玻璃体炎。他在开始抗逆转录病毒治疗2年后出现了1个月的视力模糊。目前CD4计数为40个细胞/mm，HIV病毒载量检测不到。他接受了经验性静脉抗病毒治疗，并拒绝了玻璃体腔内注射。由于临床病程恶化，进行了诊断性和治疗性玻璃体切除术，术中检查与既往CMV感染一致。房水聚合酶链反应（PCR）检测CMV呈阳性。其他感染检查无异常。玻璃体细胞学检查和流式细胞术检测玻璃体视网膜淋巴瘤均为阴性。在接受抗逆转录病毒治疗且CD4计数低（<50）的艾滋病患者中，CMV视网膜炎引起的免疫恢复性葡萄膜炎应列入亚急性玻璃体炎的鉴别诊断。
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