Asensio-Sanchez VM* and Labrador-Velandia S
Department of Ophthalmology, University Clinic Hospital of Valladolid, Spain
Received: 07 February, 2015; Accepted: 21 February, 2015; Published: 23 February, 2015
Asensio-Sanchez VM, Department of Ophthalmology, University Clinic Hospital of Valladolid, Valladolid, Avenida Ramón y Cajal, 3 -47003, Spain, 983-420000; Email:
Asensio-Sanchez VM, Labrador-Velandia S (2015) Bilateral Retrobulbar HIV Optic Neuritis. J Clin Res Ophthalmol 2(2): 026-027. DOI: 10.17352/2455-1414.000013
© 2015 Asensio-Sanchez VM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Optic neuropathy; VIH; AIDSL; Axonal degeneration
Purpose: The purpose of this report is to present a case of bilateral HIV optic neuropathy.
Methods: We describe a case of completely loss of visual acuity in the left eye (LE) and partially in the right eye (RE) in a 25-year-old Woman with HIV infection without treatment.
Results: The patient presented with visual acuity of 20/200 in the RE and amaurosis in the LE. The optic nerves showed bilateral optic disc pallor and atrophic, with more pallor LE than RE. Magnetic resonance imaging scan (MRI) showed diffuse enhancement of the bilateral optic nerves post-contrast. There was no other ocular symptom, and no evidence of retinopathy. Serological tests were only positive for HIV.
Conclusions: Ophthalmologists have the opportunity to play a key role in the diagnosis and management of this disease, important for a good visual outcome. Human immunodeficiency virus infection should be considered in the differential diagnosis of optic neuritis.
The human immunodeficiency virus (HIV) manifests in various ways in the eye. Several optic nerve disorders have been described, most commonly resulting from neoplasms, opportunistic infections, and inflammatory causes [1-4]. HIV itself may be a direct cause of optic neuropathy. It is an uncommon presentation and a diagnosis of exclusion, with only a few cases described in the literature [5-7].
The purpose of this report is to present a case of bilateral retrobulbar optic neuropathy in an HIV-positive patient without treatment.
The authors obtained written consent from the patient for the publication of her anonymised clinical data.
A 25-year-old woman presented bilateral visual loss. Past medical history was significant for HIV test in 2008 but no AIDS-defining illness. She declined antiretroviral therapy. Past ocular history was non-contributory, and results from previous eye exams were normal. She developed painful bilateral simultaneous progressive visual loss for the previous 3 months. Her best-corrected visual acuity was 20/200 OD and amaurosis OS. She saw 2/13 Ishihara plates OD and none OS. Visual field was constricted in the OD. The pupils were sluggishly reactive OU. Motility, slit lamp, and retinal exam results were normal. The optic nerves showing bilateral optic disc pallor and atrophic, with more pallor OS than OD (Figures 1, 2). An extensive evaluation for other infectious causes of her visual loss were negative. CD4+ cell count was 20/μL and serum HIV RNA level was 190,000 copies/mL. The full blood count showed leukocytosis (white cell count 13×10˄9 /L) with neutrocytosis (78%). The erythrocyte sedimentation rate was increased at 65 mm/h, with the C-reactive protein level at 7.2 mg/l. Additional laboratory tests including ANA, p/c ANCA, anti-ds DNA-Ab, antiphospholipid Ab, vitamin B12, folic acid were performed without any pathological findings. The chest radiograph was normal. A CT scan of the brain with contrast showed mild atrophy, but a magnetic resonance imaging scan (MRI) showed diffuse enhancement of the bilateral optic nerves post-contrast (Figure 3). There were no periventricular plaques. Lumbar puncture disclosed an opening pressure of 20 cm H2O and cerebrospinal fluid (CSF) chemistry and cytology were normal, including normal protein, glucose levels, and cell count. CSF cytology was negative for malignancy. Oligoclonal bands were negative. Results of a VDRL test, a Cryptococcus antigen test, an acid-fast stain, a Mycobacterium tuberculosis polymerase chain reaction (PCR) assay, and all cultures (bacteria, fungi, viruses, and mycobacteria) were negative.
- Vrabec TR (2004) Posterior segment manifestations of HIV/AIDS. SurvOphthalmol 49:131-157.
- Goldsmith P, Jones RE, Ozuzu GE, Richardson J, Ong EL (2000) Optic neuropathy as the presenting feature of HIV infection: Recovery of vision with highly active antiretroviral therapy. Br J Ophthalmol 84:551-553.
- Mwanza JC, Nyamabo LK, Tylleskär T, Plant GT (2004) Neuro-phthalmological disorders in HIV infected subjects with neurological manifestations. Br J Ophthalmol 88:1455-1459.
- Gordon LK(2005) Retroviruses and retroviral diseases. In: Miller NR,Newman NJ, eds. Walsh and Hoyt's Clinical Neuro-Ophthalmology 6thedition. Lippincott Willliamsand Wilkins 3323-3368.
- Newman NJ, Lessel S (1992) Bilateral optic neuropathies with remission in two HIV-positive men. J ClinNeruoOphthalmol 12:1-5.
- Sweeney BJ,Manji H, Gilson RJC, Harrison MJG (1993) Optic neuritis and HIV-1 infection. J NeurolNeurosurg Psychiatry 56:705-707.
- Larsen M, Toft PB, Bernhard P, Herning M (1998) Bilateral optic neuritis in acute human immunodeficiency virus infection. ActaOphthalmolScand76:737-738.
- Voss E, Raab P, Trebst C, Stangel M (2011) Clinical approach to optic neuritis: pitfalls, red flags and differential diagnosis. TherAdvNeurolDisord 4: 123-134.
- Tenhula WN, Shizao X, Madigan MC, Heller K, Freeman WR, et al. (1992) Morphometric Comparison of Optic Nerve Axon Loss in AcquiredImmunodeficiency Syndrome. Am J Ophthalmol 113:14-20.
- Sadun AA, Pepose JS, Madigan MC, Laycock KA, Tenula WN, et al.(1995) AIDS-related optic neuropathy: a histological, virological and ultrastructural study. Graefes Arch ClinExpOphthalmol 233:387-398.
- Mahadevan A, Satishchandra P, Prachet KK, Sidappa NB, Ranga U, et al. (2006) Optic nerve axonal pathology is related to abnormal visual evoked responses in AIDS. ActaNeuropathol 112:461-469.
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