CYTOMEGALOVIRUS RETINITIS AND CRYPTOCOCCUS MENINGITIS WITH PAPILITIS IN PAEDIATRIC AIDS PATIENT

Abstract

Background: The incidence of ocular complications in HIV-infected patients varies from 42% to 75% and some of these complications may lead to blindness. Here we report a rare case of retroviral disease with cytomegalovirus (CMV) retinitis in one eye and papillitis secondary to cryptococcus meningitis in the other eye.

Case Report: A 14 year old Malay girl who was diagnosed with AIDS since birth through vertical transmission presented with fever, headache, seizure and chronic poor vision in the right eye for about 8 months duration. She was on antiretroviral therapy (HAART). Visual acuity in the right eye was only perception to light and in the left eye was 6/9. Both anterior segments were unremarkable. Fundoscopy of the right eye showed generalised shallow retinal detachment and left swollen hyperaemic disc. Computed tomography (CT) scan of the brain was normal. Lumbar puncture opening pressure was normal as well. A diagnosis of retroviral disease with cryptococcal meningitis, right advanced CMV retinitis and left papillitis was made. Patient was treated with HAART regime, ganciclovir, amphotericin B, flucytosine and fluconazole. The papillitis responded well to treatment. However, the CMV retinitis persisted.

Conclusion: In conclusion, AIDS patients are susceptible to multiple opportunistic infection that may co-exist with different severity in either eye. Prompt diagnosis and early medical intervention may preserve vision and improve life expectancy.

Keywords: paediatric HIV infection, cytomegalovirus retinitis, cryptococcus papilitis, cryptococcus meningitis