1 infec 65 - tabish60102

[ArchivalUser]

A 40-year-old man with AIDS has a 1-day history of blurred vision of the right eye and a several-hour history of acute loss of vision on the right. For the past 6 months, his antiretroviral regimen has included a nucleoside reverse transcriptase inhibitor, a non-nucleoside reverse transcriptase inhibitor, and a protease inhibitor. The patient's most recent CD4 cell count was 355/μL (0.35 × 109/L), and his plasma HIV RNA viral load was 15,000 copies/mL. He has been unwilling to change therapy or to be more compliant with his drug regimen. Medical history is otherwise unremarkable.

On physical examination, vital signs are normal. Ophthalmologic examination discloses pupils that are equal and readily reactive to light. Examination of the right fundus shows a localized area of hemorrhagic necrosis of the fovea. There are no cotton-wool exudates and no uveal disorders. The remainder of the examination is normal.

After hospitalizing the patient, which of the following intravenous agents is most appropriate?

A Pyrimethamine plus oral sulfadiazine
B Acyclovir
C Ganciclovir
D Penicillin
E A corticosteroid

[ArchivalUser]

cc

[ArchivalUser]

cc

[ArchivalUser]

ccc

[ArchivalUser]

CD4 IS 355
AND ITS SEVERE EYE DISEASE

[ArchivalUser]

Sooo, if it's not c, it's eee

[ArchivalUser]

AA toxo

[ArchivalUser]

BB??HSV

[ArchivalUser]

YES HSV

[ArchivalUser]

Correct Answer = B)
Key Points

* Acute retinal necrosis occurs most often in patients with HIV infection or AIDS.
* Intravenous acyclovir is the preferred treatment for acute retinal necrosis.

This patient has acute retinal necrosis, which occurs most often in patients with HIV infection or AIDS. It is most likely caused by varicella-zoster virus or possibly by herpes simplex virus. The preferred treatment for either of these viruses is intravenous acyclovir.

Intravenous pyrimethamine and oral sulfadiazine are used to treat toxoplasmosis, which this patient is unlikely to have because his HIV infection is under control and he is therefore at significantly less risk for developing opportunistic infections. Intravenous ganciclovir is used to treat cytomegalovirus retinitis, which is also an opportunistic infection and is therefore unlikely in this patient. In addition, his ophthalmologic examination is inconsistent with retinitis, which causes floaters and photopsia (flashing lights) in addition to blurring and loss of vision. Intravenous penicillin is the agent of choice for syphilis. Corticosteroids are used to treat uveal disease, which is most likely in a patient with herpes zoster ophthalmicus.