INFECTIOUS MULTIFOCAL CHOROIDITIS IN PATIENTS WITH ACQUIRED-IMMUNE-DEFICIENCY-SYNDROME

Purpose: The purposes of this study are to determine the incidence of infectious opportunistic choroiditis in patients with the acquired imm une deficiency syndrome (AIDS), to study the association of these chor oidal infections with systemic dissemination, and to investigate the l ife expectancy and cause of death in patients with infectious opportun istic choroiditis. Methods: A total of 470 eyes of 235 consecutive aut opsies of patients with AIDS were examined by histopathologic methods. The clinical charts and autopsy reports of these patients were subseq uently reviewed for presence of systemic dissemination of various infe ctious agents. Results: Of the 235 patients, 18 were found to have inf ectious choroiditis. The etiologic agents found were: Cryptococcus neo formans, Pneumocystis carinii, Mycobacterium tuberculosis, Histoplasma capsulatum, Candida, Aspergillus fumigatus, Toxoplasma gondii, and My cobacterium avium-intracellulare. In 15 of these 18 patients, the caus e of death was considered to be due to systemic dissemination of the o rganism causing the choroiditis. Only 4 of the 18 cases of infectious choroiditis were diagnosed during life, and the survival time of these patients after diagnosis was only 25 days. Five of the 18 patients al so were found to have cytomegalovirus (CMV) infection of the retina. C onclusion: Multifocal choroiditis due to endogenous infectious emboli in patients with AIDS reflects systemic dissemination and localization of infectious agents predominantly in the choriocapillaris. Early dia gnosis and treatment are imperative and may be life-saving.