Massive mycobacterial choroiditis during highly active antiretroviral therapy: another immune-recovery uveitis?

Ophthalmology. 2002 Nov;109(11):2144-8. doi: 10.1016/s0161-6420(01)01048-x.


Purpose: To describe the ocular presentation of disseminated mycobacterial disease occurring during immune-recovery in a patient with acquired immune deficiency syndrome (AIDS).

Study design: Case report and literature review.

Participants: A 41-year-old AIDS patient with a prior diagnosis of cytomegalovirus retinitis.

Methods: The patient developed progressive, bilateral multifocal choroiditis with panuveitis 2 months after beginning and responding to highly active antiretroviral therapy. His left eye became blind and painful and was enucleated. Pathologic examination revealed massive choroiditis with well-formed, discrete granulomas and multiple intracellular and extracellular acid-fast organisms within the choroidal granulomas. Culture and polymerase chain reaction of vitreous specimens revealed Mycobacterium avium complex (MAC).

Results: Empiric, and later sensitivity-guided, local and systemic antibiotic therapy was used to treat the remaining right eye, but it continued to deteriorate. Despite medical therapy, three vitrectomies and repeated intravitreal injections of amikacin, a total retinal detachment ensued. One week after the third vitrectomy, the patient died from mesenteric artery thrombosis in the setting of disseminated mycobacterial disease.

Conclusions: This is the first report of ocular inflammation as the presenting finding in the recently recognized syndrome of immune-recovery MAC disease. Pathogenesis of this entity is related to an enhanced immune response to a prior, subclinical, disseminated infection. The formation of discrete granulomas, normally absent in MAC infections in AIDS, reflects this mechanism.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnosis
  • AIDS-Related Opportunistic Infections / drug therapy
  • AIDS-Related Opportunistic Infections / microbiology*
  • Adult
  • Antiretroviral Therapy, Highly Active*
  • Choroiditis / diagnosis
  • Choroiditis / drug therapy
  • Choroiditis / microbiology*
  • Cytomegalovirus Retinitis / diagnosis
  • Cytomegalovirus Retinitis / drug therapy
  • Cytomegalovirus Retinitis / microbiology
  • DNA, Bacterial / genetics
  • Eye Infections, Bacterial / diagnosis
  • Eye Infections, Bacterial / drug therapy
  • Eye Infections, Bacterial / microbiology*
  • Fatal Outcome
  • Granuloma / diagnosis
  • Granuloma / drug therapy
  • Granuloma / microbiology
  • Humans
  • Male
  • Mycobacterium avium Complex / genetics
  • Mycobacterium avium Complex / isolation & purification*
  • Mycobacterium avium-intracellulare Infection / diagnosis
  • Mycobacterium avium-intracellulare Infection / drug therapy
  • Mycobacterium avium-intracellulare Infection / microbiology*
  • Panuveitis / diagnosis
  • Panuveitis / drug therapy
  • Panuveitis / microbiology*
  • Polymerase Chain Reaction


  • DNA, Bacterial