TRIPLE RETINAL INFECTION WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1, CYTOMEGALOVIRUS, AND HERPES-SIMPLEX VIRUS TYPE-1 - LIGHT AND ELECTRON-MICROSCOPY, IMMUNOHISTOCHEMISTRY, AND IN-SITU HYBRIDIZATION

Purpose: This report describes the histopathologic and virologic findi ngs of the retina from a 55-year-old bisexual patient with the acquire d immune deficiency syndrome (AIDS), who had concurrent human immunode ficiency virus type 1 (HIV-1), cytomegalovirus (CMV), and herpes simpl ex virus type 1 (HSV-1) retinitis, and was treated with ganciclovir. M ethods: The eyes were obtained at autopsy and processed for light micr oscopy and transmission electron microscopy. Immunohistochemical stain s for HSV-1, CMV, HIV-1, varicella tester virus, and glial fibrillary acidic protein were carried out using the peroxidase-antiperoxidase an d streptavidin-biotin-alkaline phosphatase techniques. For in situ hyb ridization, a radiolabeled CMV DNA probe (Eco-RI-Y fragment of strain AD 169) was used. Results: Results of histopathologic examination show ed a full-thickness necrotizing retinitis with cytomegalic and herpes viral intranuclear inclusions in cells of the neurosensory retina, ret inal vascular endothelium, and the retinal pigment epithelium. Some ar eas of the retina were replaced by glial tissue. The choroid contained only a few chronic inflammatory cells. Immunoperoxidase studies discl osed CMV antigens diffusely distributed throughout all layers of the r etina and the retinal pigment epithelium. Herpes simplex virus type 1 antigens were present in retinal cells and the retinal vascular endoth elium. Human immunodeficiency virus type 1 antigens were found in mono nuclear cells in all layers of the sensory retina. Dual infections wit h HIV-1 and CMV of individual multinucleated giant cells of glial orig in were demonstrated immunohistochemically.