Unilateral Frosted Branch Angiitis as A Rare Presenting Clinical Manifestation in AIDS patient in Ciptomangunkusumo Hospital Indonesia

1.Rini Sulastiwaty
2.Soedarman Sjamsoe
3.Made Susiyanti
4.Lukman Edward
5.Rina La Distia Nora

1. Department of Ophthalmology, Faculty of Medicine University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Purpose
To report a case of unilateral frosted branch angiitis as a rare ocular clinical manifestation in HIV/AIDS patient in FKUI/Ciptomangunkusumo Hospital Indonesia.

Method
A 38-years-old male presented with a 3-weeks history of blurred vision in the right eye and the visual acuity is 1/60 while the left eye is 6/6. Patient is HIV +, CD4 95 cell/µl, HBSAg+, IgG CMV is 91.00 AU/ml (+), and IgG HSV 1 is 4.34 (reactive), IgG Toxoplasma 0.1 IU/ml (non reactive) and acid fast bacilli from sputum is negative. Anterior segment is quiet and vitreous is clear. PCR of the vitreous was not performed. The fundus showed papillitis and frosted branch angiitis. The "cottage cheese and ketchup" traditional description of CMV was found in superotemporal arcade. The left eye showed a few cotton wool spots but no retinitis. He was treated with Gancyclovir intra vitreal injection.

Results
Patient received HAART therapy a week before the Gancyclovir injection therapy began. In two months CD4 raised to 223 cell/µl and the visual acuity of right eye is improving to 6/7.5.

Conclusions
Unilateral of frosted branch angiitis in AIDS patient is a rare manifestation. PCR was not performed but CMV retinitis was suspected based on the fundus appearance. Gancyclovir intravitreal injection therapy gave a succesful result in improving the visual acuity.