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Presumed Pneumocystis carinii choroiditis. Unifocal presentation, regression with intravenous pentamidine, and
R E Foster1, C Y Lowder, D M Meisler
1Department of Ophthalmology, Cleveland Clinic Foundation, OH 44195-5024.
Abstract:
Pneumocystis carinii choroiditis is a well-documented but rare infection that has been described as a bilateral, multifocal process. Treatment efficacy has not been well established. In this report, three cases of presumed P. carinii choroiditis that developed during aerosolized pentamidine therapy for the prophylaxis of P. carinii pneumonia are described. All patients had unilateral choroiditis, and two patients were first observed to have unifocal choroiditis. In all patients, choroidal lesions decreased in size with intravenous pentamidine treatment. Choroiditis exacerbated in the two unifocal cases after the frequency of maintenance intravenous pentamidine therapy was decreased. P. carinii choroiditis may appear as a unifocal, unilateral lesion that may represent an earlier stage of infection than previously described. Intravenous pentamidine therapy appears to control P. carinii choroiditis but may need to be continued to prevent exacerbation. Patients receiving prophylactic aerosolized pentamidine therapy are not protected against extrapulmonary disease, and presumed P. carinii choroiditis may serve as a marker for disseminated infection.
Insights
Pneumocystis carinii choroiditis can present as a unilateral lesion, even during prophylactic therapy. Intravenous pentamidine controls this rare infection but requires ongoing treatment to prevent recurrence.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Medical Mycology
Background:
- Pneumocystis carinii choroiditis is a rare, typically bilateral and multifocal infection.
- Treatment efficacy for P. carinii choroiditis remains poorly established.
Observation:
- Three cases of P. carinii choroiditis occurred during aerosolized pentamidine prophylaxis for P. carinii pneumonia.
- All observed cases presented as unilateral choroiditis, with two initially unifocal.
- Choroidal lesions regressed with intravenous pentamidine but recurred upon decreased therapy frequency.
Findings:
- P. carinii choroiditis can manifest as an early, unifocal, unilateral lesion.
- Intravenous pentamidine effectively controls choroiditis but necessitates continuous administration to prevent relapse.
- Prophylactic aerosolized pentamidine does not prevent extrapulmonary P. carinii infections.
Implications:
- P. carinii choroiditis may indicate disseminated P. carinii infection in patients on prophylactic therapy.
- Continuous intravenous pentamidine is crucial for managing P. carinii choroiditis and preventing exacerbations.
- Clinical presentation of P. carinii choroiditis may be broader than previously recognized, including unifocal, unilateral forms.