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Ocular Infection with Mycobacterium Kansasii in a Patient with HIV

1Best J., 2Goebels K., 1Althaus C.,
1Heinrich-Heine-Universität Düsseldorf, Universitäts-Augenklinik (Düsseldorf)
2Heinrich-Heine-Universität Düsseldorf, Klinik für Gastroenterologie und Infektiologie (Düsseldorf)

Purpose: Opportunistic infections with Mycobacterium kansasii are common complications of the aquired immunodeficiency syndrome (AIDS). Mycobacterium kansasii infection occurs late in the course of HIV disease and is associated with advanced immunosuppression. Normaly patients have pulmonary disease. Extrapulmonary infection is rare. An ocular infection has not been described so far.
Case report: A 32-year old native greek patient was first seen in our out-patient-department in August 2001. We diagnosed a progressive CMV-retinitis and –papillitis of the left eye. Due to bad adherence we saw the patient 4 months later and diagnosed a rhegmatogenic retinal detachment and a phthisis bulbi. Due to the severe pain we suggested an enucleation but the patient refused. At the next consultation in January 2002, he presented with a massive endophthalmitis and a subconjunctival swelling in the superotemporal quadrant suggestive of a scleral penetration of the putride inflammation. CT-scan showed no orbital involvement. The amaurotic and infected eye was enucleated.
Results: The histological examination showed acid-fast-bacilli in the anterior and posterior ocular segment with scleral penetration into the subconjunctival space. Microbiological culture and DNA-hybridisation confirmed the diagnosis of an ocular infection with Mycobacterium kansasii.
Conclusions: Mycobacterium kansasii infection occured late in the course of HIV disease and was associated with advanced immunosuppression. Extrapulmonary infection is rare. This is the first report of ocular involvement.