A 49-year-old Caucasian male was admitted to the Patras University Hospital, presenting with a 10-day history of fever, severe headache, and dizziness. Cerebrospinal fluid examination revealed cryptococcal meningitis. The patient was also diagnosed with pulmonary tuberculosis and HIV infection, with a CD4 count of 45 cells/microL and HIV viral load of 873,083 copies/mL. Upon diagnosis, treatment with liposomal amphotericin B, fluconazole, and antituberculosis agents was commenced.
After 7 weeks of treatment and before initiation of antiretroviral therapy (commenced 2 months after the admission), the patient complained of a decrease in visual acuity affecting the right eye and was referred to the ophthalmology department. There was no history of previous ocular disease or surgery, and the patient's best corrected visual acuity (BCVA) was 9/10 OD and 10/10 OS. Anterior segment evaluation was unremarkable. Dilated fundus examination revealed cotton wool spots and pre- and intraretinal hemorrhages in both eyes compatible with HIV retinopathy (Fig. 1a, b).
Spectral-domain OCT (SD-OCT, Spectralis HRA + OCT; Heidelberg Engineering GmbH, Heidelberg, Germany) revealed the presence of INL thinning below the fovea in OD in the parafoveal area in OD and OS (Fig. 1c-h). OCT angiography (OCTA; Triton Swept Source OCT, Topcon) revealed areas of DCP ischemia devoid of capillaries (Fig. 2a, b). Fluorescein angiography revealed microaneurysms and areas of late leakage in both eyes (Fig. 2c, d and 3a, b). Visual field (VF) testing (Zeiss Humphrey Field Analyzer 3) documented the presence of central (OD) and paracentral (OD and OS) scotomas (Fig. 4a, b).