Pneumocystis jirovecii Choroiditis
Patients with AIDS are at greater risk for P jirovecii pneumonia. In rare cases, this infection can result in choroidal infiltrates that contain the microorganisms.
P jirovecii can present as choroiditis that consists of slightly elevated, plaquelike, yellow-white lesions located in the choroid, with minimal vitritis (Fig 15-4). On fluorescein angiography, these lesions tend to be hypofluorescent in the early phase and hyperfluorescent in the later phases. If disseminated P jirovecii infection is suspected, an extensive examination is required by an infectious disease specialist.
Treatment of P jirovecii choroiditis involves a 3-week regimen of intravenous trimethoprim (20 mg/kg/day) and sulfamethoxazole (100 mg/kg/day) or pentamidine (4 mg/kg/day). Within 3–12 weeks, most of the yellow-white lesions disappear, leaving mild overlying pigmentary changes. Vision is usually not affected.
Figure 15-4 Fundus photograph of Pneumocystis jirovecii choroiditis. The fellow eye revealed similar findings.
(Reprinted with permission from Cunningham ET Jr, Belfort R Jr. HIV/AIDS and the Eye: A Global Perspective. Ophthalmology Monograph 15. San Francisco, CA: American Academy of Ophthalmology; 2002:67.)
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.