A carregar...
Publicação
Retinite a citomegalovírus em doente com SIDA : caso clínico e revisão de literatura
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 4.01 MB | Adobe PDF |
Orientador(es)
Resumo(s)
A retinite a citomegalovírus (CMV) é a mais frequente das manifestações da doença a CMV nos doentes com infeção pelo vírus da imunodeficiência humana (HIV). Os doentes com avançada imunossupressão encontram-se suscetíveis à reativação do vírus e ao desencadear de doença grave. O CMV atinge a retina por disseminação hematogénea, provocando lesões caracteristicamente necrotizantes e hemorrágicas. A prevalência da retinite a CMV diminuiu à custa da terapêutica antirretroviral (TARV), no entanto, continua a ser a mais grave complicação ocular. Os fármacos mais utilizados para o seu tratamento são o ganciclovir, o valganciclovir e o foscarnet. Todos parecem ter eficácias semelhantes, sendo a escolha adaptada às características da retinite e do doente. Os autores relatam o caso de uma doente de 29 anos com síndrome da imunodeficiência adquirida (SIDA), com antecedentes de retinite a CMV, que recorreu ao serviço de urgência por visão turva do olho direito com uma semana de evolução, tendo-se verificado acuidade visual 7/10 e à fundoscopia focos de retinite hemorrágica. O olho esquerdo não apresentou alterações. A doente foi tratada com valganciclovir oral e injeções intravítreas de foscarnet. O seguimento até às 6 semanas mostrou melhoria das lesões, com manutenção da acuidade visual. O rastreio oftalmológico é fundamental para permitir um diagnóstico atempado e tratamento adequado da retinite a CMV, tendo em vista a preservação da acuidade visual.
Cytomegalovirus (CMV) retinitis is the most frequent manifestation of CMV disease in patients with human immunodeficiency virus (HIV). Patients with advanced immunosuppression are susceptible to reactivation of the virus and the onset of serious illness. CMV affects the retina by hematogenous spread, characteristically causing necrotizing and hemorrhagic lesions. The prevalence of CMV retinitis decreased at the expense of antiretroviral therapy (ART), however, it remains the most serious ocular complication. The most commonly used drugs for its treatment are ganciclovir, valganciclovir and foscarnet. They seem to have similar efficacy, with an individual and adapted choice to the retinitis and patient characteristics. We report the case of a 29-years-old female with acquired immune deficiency syndrome (AIDS), with history of CMV retinitis, that presented in the emergency room with blurred vision of the right eye with a week of evolution. On examination, visual acuity was 7/10 and fundoscopy revealed areas of hemorrhagic retinitis. The left eye was unremarkable. The patient was treated with oral valganciclovir and intravitreal injections of foscarnet. The follow-up at 6 weeks showed improvement of the lesions and maintenance of visual acuity. The ophthalmological screening is essential to enable an early diagnosis and an appropriate treatment of CMV retinitis, in order to preserve the visual acuity.
Cytomegalovirus (CMV) retinitis is the most frequent manifestation of CMV disease in patients with human immunodeficiency virus (HIV). Patients with advanced immunosuppression are susceptible to reactivation of the virus and the onset of serious illness. CMV affects the retina by hematogenous spread, characteristically causing necrotizing and hemorrhagic lesions. The prevalence of CMV retinitis decreased at the expense of antiretroviral therapy (ART), however, it remains the most serious ocular complication. The most commonly used drugs for its treatment are ganciclovir, valganciclovir and foscarnet. They seem to have similar efficacy, with an individual and adapted choice to the retinitis and patient characteristics. We report the case of a 29-years-old female with acquired immune deficiency syndrome (AIDS), with history of CMV retinitis, that presented in the emergency room with blurred vision of the right eye with a week of evolution. On examination, visual acuity was 7/10 and fundoscopy revealed areas of hemorrhagic retinitis. The left eye was unremarkable. The patient was treated with oral valganciclovir and intravitreal injections of foscarnet. The follow-up at 6 weeks showed improvement of the lesions and maintenance of visual acuity. The ophthalmological screening is essential to enable an early diagnosis and an appropriate treatment of CMV retinitis, in order to preserve the visual acuity.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Retinite Citomegalovírus Valganciclovir Foscarnet Síndrome da imunodeficiência humana adquirida (SIDA) Oftalmologia