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Impressum
The Differential Diagnosis of not HIV-associated Necrotizing Retinopathies
Schwarz J., Körner U., Garweg J. G.
Univ.-Augenklinik, Inselspital, 3010 Bern
Background: The diagnosis of not HIV-associated necrotizing retinopathies
is often difficult to obtain as it usually is lacking laboratory confirmation.
A broad differential diagnosis and the importance of immunogenetic influences
on the likelihood and frequences of distinct disease groups such as M.
Behcet may further contribute.
Patients and Methods: Therefore we reviewed retrospectively the
records of all patients with not HIV-associated necrotizing retinopathies
who had presented to the uveitis ambulance of our outpatient clinic over
the past five years. In all circumstances, a close follow up included
clinical course and photo documentation, broad serological investigations,
eventually supplemented by aqueous humor analysis, fluorescein angiography
and further medical diagnostics according to clinical judgement to generate
a differential diagnosis and provide a therapeutic concept.
Results: a definitive diagnosis was obtained in 21/25 cases (84%),
usually only after inclusion of the clinical response to therapy. In 9
cases, a infectious etiology was found (atypical toxoplasmosis: 5 cases,
a VZVassociated retinal necrosis in 3 and a CMV-associated one in 2 cases).
In 8 instances, an underlying immunological disease was confirmed (6 x
M. Behcet, 2 x VKH syndrome). Three times, an acute hypertensive retinopathy
was misinterpreted as infectious retinal necrosis, and once a severe immunoglobulin
deficiency with panophthalmia was diagnosed.
Conclusion: In only 40% of cases an infectious etiology was confirmed,
half of which were attributable to atypical ocular toxoplasmosis. The
most common immunological disorder was M. Behcet. A clinical affiliation
was usually possible in infectious retinopathies, whereas in inflammatory
occlusive vasculopathies such as M. Behcet and Lupus-associated retinal
vasculitis the clinical course under therapy had to be taken into account
for a definitive diagnostic categorization.