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Case Reports
. 2023 Apr 6;16(4):e252710.
doi: 10.1136/bcr-2022-252710.

Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic

Chaitra Jayadev  1 , Srinivasan Sanjay  2 , Ashit Handa  3 , Sameeksha Agrawal  3
Affiliations
Case Reports

Human immunodeficiency virus retinopathy with presumed cytomegalovirus retinitis with macular oedema in a diabetic

Chaitra Jayadev et al. BMJ Case Rep. .

Abstract

A man in his early 50s on regular follow-up for a stable non-proliferative diabetic retinopathy (NPDR) presented with decreased vision, worsening of retinal pathology and macular oedema in both eyes. His corrected distance visual acuity (CDVA) was 6/9 in the right eye and 6/15 in the left eye and fundus examination showed multiple intraretinal haemorrhages in all quadrants. His systemic workup revealed a severe thrombocytopaenia, which prompted a further detailed systemic evaluation revealing him to be positive for HIV with retinopathy complicating the pre-existing NPDR. Given the significant inflammation and macular oedema, a cocktail of intravitreal bevacizumab, ganciclovir and dexamethasone was administered. The retinopathy and macular oedema resolved and the CDVA improved to 6/6 in both eyes over a 6-month follow-up period. Any sudden worsening of fundus findings in a patient with diabetes necessitates immediate and detailed ocular and systemic evaluation, especially when the immune status is unknown.

Keywords: HIV / AIDS; Macula; Retina.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Moderate non-proliferative diabetic retinopathy in the right eye on routine check 6 months ago.
Figure 2
Figure 2
Moderate non-proliferative diabetic retinopathy in the left eye on routine check 6 months ago. HD; High Definition.
Figure 3
Figure 3
Optical coherence tomography of the right eye on routine check 6 months ago.
Figure 4
Figure 4
Optical coherence tomography of the left eye on routine check 6 months ago.
Figure 5
Figure 5
Fundus picture of the right eye at presentation. HD; High Definition
Figure 6
Figure 6
Fundus picture of the left eye at presentation. HD; High Definition
Figure 7
Figure 7
Fundus fluorescein angiography of the right eye showing no evidence of neovascularisation or inflammation.
Figure 8
Figure 8
Fundus fluorescein angiography of the left eye showing areas of capillary non perfusion but no evidence of neovascularisation or inflammation.
Figure 9
Figure 9
Optical coherence tomography of the right eye showing macular oedema and subretinal fluid.
Figure 10
Figure 10
Optical coherence tomography of the left eye showing macular oedema and subretinal fluid.
Figure 11
Figure 11
Fundus picture of the right eye 2 months later showing retinitis patches.
Figure 12
Figure 12
Fundus picture of the left eye 2 months later showing retinitis patches.
Figure 13
Figure 13
Optical coherence tomography of the right eye 2 months later showing worsening of macular oedema and subretinal fluid.
Figure 14
Figure 14
Optical coherence tomography of the left eye 2 months later showing worsening of macular oedema and subretinal fluid.
Figure 15
Figure 15
Fundus picture of the right eye on last follow-up showing resolution of retinitis.
Figure 16
Figure 16
Fundus picture of the left eye on last follow-up showing resolution of retinitis.
Figure 17
Figure 17
Optical coherence tomography of the right eye on last follow-up showing resolution of the macular oedema.
Figure 18
Figure 18
Optical coherence tomography of the left eye on last follow-up showing resolution of the macular oedema.
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