Pneumocystis

This patient had a known history of treated HIV infection and presented with asymptomatic bilateral irregularly round patches of choroidal and RPE pigmentary loss.

Our patient’s findings show what the lesions of pneumocystis choroiditis look like upon resolution.

Learning Points:
In the early days of the HIV/AIDS epidemic, pneumocystis pneumonia was one of the most common opportunistic infections. Aerosolized pentamidine was therefore given as prophylaxis. The medication, however, did not reach the entire lungs, and patients often had septic pneumocystis emboli from an incompletely treated pneumonia.

Pneumocystis choroiditis was a rare manifestation of this systemic infection, where patients developed multifocal, flat, bilateral choroidal lesions that were usually asymptomatic and had a striking absence of inflammation.

Systemic prophylaxis was subsequently recommended, which better treated the underlying pneumonia and prevented systemic infection.

Highly active antiretroviral therapy (HAART), introduced in the late 1990’s, restores the health of the underlying immune system and has turned this type of finding into something for the history books.