A case and literature review of intraocular echinococcus causing bilateral visual loss in a HIV-infected patient

Abstract

Although echinococcosis is a common parasitic disease endemic to Africa, ocular echinococcosis is rare. We present a case of intraocular echinococcosis in a HIV-infected patient. A 38-year-old South African HIV-infected woman presented to a district-level hospital in Kwa-Zulu Natal on 10 March 2020. Her main presenting complaint was that of progressive, painless, bilateral visual loss. A B-ultrasonography scan revealed tractional retinal detachment on the right eye, while the left eye had tractional bands with a ‘double-walled’ cystic cavity causing retinal traction. A systemic work-up revealed a positive Echinococcus ELISA IgG with a value of 1.3, eosinophilia of 5.70% (0.41 × 109), and elevated C-reactive protein and erythrocyte sedimentation rate of 47 mg/L and 93 mm/hr, respectively. Based on the above clinical, biochemical and ultrasonographical evidence, a diagnosis of ocular echinococcosis was made. Our differential diagnosis includes toxic optic neuropathy, Jarisch-Herxheimer-like reaction secondary to immune reconstitution and necrotizing herpetic retinitis. She was initiated on topical and intravitreal steroids which led to decreased intraocular inflammation and dry maculae. Five months after presentation, her visual acuity remained unchanged with no light perception in both eyes. We conclude that ocular echinococcosis, although rare, can lead to severe visual impairment as there are no known definite treatment modalities for intraocular hydatid disease. Reports on co-infections with HIV and Echinococcus are limited with a potential scope for research.

Equinococosis quística peritoneal diseminada en paciente con infección por VIH: reporte de caso

“…Recently, HIV has been reported to be the most frequent immunodeficient infection in patients with CE 2 . In addition, some reports show that extrahepatic cystic disease is more frequent in people with HIV 7 , as has been described in cases with unusual locations such as the brain 13 , spinal cord 14 , eyeball 15 , kidney 16 , kidney-liver 17 ) and peritoneal 18 . Most of these cases occurred in women 2 .…”

“…Recientemente, se ha informado que el VIH es la infección inmunodeficiente más frecuente en pacientes con EQ (2) . Además, algunos reportes indican que la enfermedad quística extrahepática es más común en la población con VIH (7) , tal como se ha descrito en casos con localizaciones poco comunes como cerebro (13) , médula espinal (14) , globo ocular (15) , renal (16) , hepatorrenal (17) y peritoneal (18) . La mayor parte de estos casos han ocurrido en mujeres.…”

An Unusual Cause of Serous Retinal Detachment

“…Williams et al reported a choroidal hydatid cyst accompanied by multiorgan involvement in an Alaskan patient [7]. In South Africa, Konar and Pillay reported visual loss in a HIV-infected patient due to bilateral echinococcus cysts and tractional retinal detachment [8]. Guo et al reported a subretinal cyst accompanied by multiple brain lesions in a 37year-old Tibetan patient [9].…”