Retinal complications in the acquired immunodeficiency syndrome. A case report
Welsh, N.H.; Swartz, J.; Martin, C.; Salmenson, B.D.; James, S.H.; Zwi, S.
South African Medical Journal 71(6): 394-396
1987
ISSN/ISBN: 0256-9574 PMID: 3563780 Document Number: 304362
A 34-year-old man was admitted to Johannesburg Hospital, South Africa, in December 1984 complaining of cough, fever, progressive breathlessness, and weight loss. He had recently returned from the USA where he had been diagnosed as having AIDS, complicated by Kaposi's sarcoma, hepatitis, Pneumocystis carinii, Mycobacterium tuberculosis and herpes simplex. He was treated in the USA with iv trimethoprim sulphamethoxazole (TMP-SMX) for P. carinii and isoniazid, ethambutol and rifampicin for tuberculosis. Fibre-optic bronchoscopy and transbronchial biopsy were performed and P. carinii was diagnosed; the patient responded to iv TMP-SMX treatment. However, the patient developed an ulnar nerve lesion and impaired visual acuity in his right eye (cotton-wool spots which developed into cytomegalovirus retinitis). Candidal oesophagitis became manifest and responded to ketoconazole therapy. The patient was discharged on prophylactic antituberculosis therapy and oral TMP-SMX. The patient's condition gradually deteriorated over the next 6 months and he died on 28 July 1985. Autopsy showed that death was due to suppressive bronchopneumonia with evidence of cytomegalovirus infection.