Diagnosis and treatment of NMOSD associated with HIV infection/AIDS: case report and literature review
Journal Title: Eye Science (Yanke Xuebao) - Year 2023, Vol 38, Issue 3
Abstract
A case of neuromyelitis optica spectrum disorders (NMOSD) complicated with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS) was reported, and the pathogenesis, clinical characteristics, treatment and prognosis were summarized through the literature review. The retrieved literatures included seven English literatures (eight cases) and one Chinese literature, in which a total of nine cases of NMOSD co-infected with HIV infection/AIDS were reported. Combined with the case reported in this paper, the total number of cases was ten, among which five cases were female and five cases were male, three cases of HIV infection/AIDS were newly developed, and the other cases had earlier onset of HIV infection/AIDS than NMOSD. In terms of clinical manifestations, seven cases all had simultaneous or sequential optic nerve and myelitis, two patients presented with a uniphasic course or recurrent myelitis, and one case presented only with bilateral optic neuritis occurring sequentially in both eyes. All ten patients had typical abnormal signals of the optic nerve or spinal cord with or without enhancement on cranial or spinal MRI. Two patients did not undergo AQP4 antibody IgG testing, and of the remaining seven cases, five were positive for AQP4 antibodies and three were negative. For AIDS treatment, eight of the ten patients received highly active antiretroviral therapy (HAART). For NMOSD treatment, among the ten patients, eight patients received intravenous methylprednisolone, three patients received plasmapheresis, and two patients received intravenous immunoglobulin in the acute phase. Six patients received immunosuppressive therapy during the sequential treatment period, and one of them was discontinued due to hyperbilirubinemia. Of the seven cases with optic neuritis, two patients remained blind after treatment and five had partial recovery of vision. Of the eight cases with myelitis, five patients were left with paraplegia or mild paralysis, and three had partial recovery of muscle strength. One case died due to serious complications. NMOSD combined with HIV infection/AIDS is rare in clinic and has a poor prognosis. Patients are often left with severe visual impairment and paralysis. Clinical treatment is quite difficult, hormones and immunosuppressive agents are not considered as contraindications. Treatment decisions need to be made with fully considered about the balance of risks and benefits.
Authors and Affiliations
Min TANG, Youyi LI, Xiaohong XIANG, Yang CAO, Yaling FENG, Hongbin LV
Keywords
Related Articles
- EP ID EP764622
- DOI 10.12419/j.issn.1000-4432.2023.02.14
- Views 9
- Downloads 0
Application of job demand-oriented training model in specialized training of sterile supplying for nurses in ophthalmic operation room
[Objective:] To explore the application effect of job demand-oriented training model in specialized training of sterile supplying for nurses in the ophthalmic operation room. [Methods:] A total of 44 nurses who would wor...
General practice management of diabetic retinopathy
Diabetic retinopathy is one of the microvascular diseases caused by diabetes, it is an irreversible blindness eye disease. According to its course, it can be divided into non-proliferative diabetic retinopathy and prolif...
Application of supervised teaching clinic in standardized training of ophthalmology residents
[Objective:] To explore the application and effects of supervised teaching clinic in standardized training of ophthalmology residents. [Methods:] A weekly supervised teaching clinic was set through reasonable scheduling...
Correlation between morphological changes on optical coherence tomography and visual acuity in idiopathic macular epiretinal membranes
[Objective:] To investigate the morphological changes detected by spectral domain optical coherence tomography (OCT) and their relevance to vision in patients with idiopathic macular epiretinal membranes (IMEM). [Methods...
Clinical analysis and treatment of hysterical visual impairment in children
[Objective:] To analyze the causes of hysterical visual impairment in children, and to compare the efficacy of two treatments of trial frame and artificial tears administration. [Methods:] A total of 36 children with sud...