Uncommon ocular presentations of Immune recovery phenomenon in AIDS

S Sudharshan

Aim: To describe atypical ocular presentations of immune recovery phenomenon in patients with acquired immunodeficiency syndrome(AIDS) on Highly Active Antiretroviral therapy(HAART).

Material and Methods: Case files of all those patients on HAART seen between 2005– 2010 with immune recovery uveitis(IRU) and a minimum follow-up of 6 months. Patients with atypical ocular presentations of IRU among these were included in the study. Immune recovery as defined by an increase in their CD4+T cell counts by atleast more than 100/µL and subsequently developed IRU were included. Patients treated with cidofovir and inadequate medical records were excluded from the study.

Results: 5 patients with uncommon/atypical presentations of immune recovery phenomenon were included. Two patients had IRU in the form of CMV vasculitis-phlebitis and arteritis–1 each. One patient with CMV presented with immune recovery adrenalitis and developed addison's disease. One patient with tuberculosis developed panophthalmitis after immune recovery. One patient with past history of cryptococci developed sixth nerve palsy and disc edema after immune recovery.

Conclusions: Patients on HAART should be followed up closely for development of IRU. IRU in patients post CMV retinitis(CMVR) can have atypical presentations. It can even occur in other organs post CMVR. IRU can follow tuberculosis infection and can even lead to loss of eye. Rare presentations of papilledema and cranial nerve palsies can occur with immune recovery post-cryptococci infection. Identification of such uncommon presentations of immune recovery phenomenon and appropriate management can save vision and eye.