Revista de SIDA e investigación clínica

Cytomegalovirus Retinitis with Multiple Co Infections in a HIV/AIDS Patient having Extreme Low CD4 Count: A Case Report and Review of Literature

Abstract

Avirup Chakraborty, Sattik Siddhanta, Chandrav De, Sohinee Bhattacharyya, Shuvashish Kamal Guha, Krishnendu Sarkar and Nilanjan Chakraborty

Introduction: HIV infection leads to a decrease in the CD4 count ultimately leading to the development of AIDS. Under this condition, within the body of the host several OIs manifest their pathological effects. With progressive decrease in CD4 count and with HIV disease progression, the pathogenic effects of these OIs increase several folds. Under this condition, dissemination of multiple infections is extremely common. Report of case: A 28 year old male patient presented with complaints of weakness, fever, weight loss, dry cough, respiratory distress and dimness of vision. He was HIV sero positive with CD4 count of 0.1 cells/μl of blood. Indirect opthalmoscopic investigations revealed Cytomegalovirus (CMV) retinitis. Treatment with wide spectrum antibiotics could not improve his respiratory distress. Broncoscopy or lung biopsy could not be performed due to his poor general condition. CMV PCR revealed high titre (5.1×107 copies of DNA/ml serum). In anticipation that his respiratory distress might be caused due to infiltration of CMV into the lungs and also to combat retinitis, i.e. Ganciclovir was started. On treatment, patient became afebrile and there was significant radiological improvement of pneuomonitis. He later developed urinary tract infection of Pseudomonas aeruginosa and was treated with Cotrimoxazole (800 mg). With HAART, CD4 increased to 66. Patient’s visual acuity improved slightly in left eye. Discussion: Early detection and prompt treatment of HIV and associated OIs is of utmost importance. The symptoms of Cytomegalovirus Retinitis are subtle and nonspecific. So, the clinician must have a high index of suspicion for diagnosing CMV retinitis. At extremely low CD4 counts, a disseminated cytomegalovirus infection should always be considered as a likely etiology of Pneumonitis. A CD4 Count of 0.1 cells/μl has made the case more novel. The initiation of HAART at extremely low CD4 counts may boost the immune system with rapid increase in CD4 coun