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COMPREHENSIVE IHUMAN CASE WEEK
A 33 yo healthy, asymptomatic medical
student with no significant PMH presents
with the posterior pole appearance
1. Patient Biodata
- Age: 33 years
- Sex: Female
- Occupation: Medical student
- Past Medical History: None significant
- Medications: None
- Allergies: None known
- Reason for Evaluation: Abnormal posterior pole appearance on fundoscopic examination
2. History
A 25-year-old previously healthy and asymptomatic medical student is noted to have an abnormal posterior pole appearance during an ophthalmologic evaluation. He denies visual complaints, eye pain, redness, photophobia, or floaters. There is no history of diabetes, hypertension, trauma, or autoimmune disease.
3. History of Present Illness (HPI)
- Onset: Incidental finding
- Symptoms: None
- Vision changes: Denied
- Pain: None
- Systemic symptoms: Denied
- Functional impact: None
- Fundoscopy shows posterior pole abnormalities consistent with cotton wool spots
- No hemorrhages, no macular edema
- Visual acuity intact
- Normal intraocular pressure
A – Assessment
Findings are most consistent with HIV microangiopathy , characterized by retinal microvascular ischemia.
P – Plan
- Recommend HIV testing
- Refer for infectious disease evaluation if positive
- Baseline ophthalmology follow-up
- Counsel patient regarding implications
9. PowerPoint Outline (Suggested Slides)
- Title Slide – Posterior Pole Abnormalities Case
- Patient Biodata
- Clinical Presentation
- Fundoscopic Findings
- Differential Diagnosis
- HIV Microangiopathy
- Pathophysiology
- Diagnostic Workup
- Management
- Prognosis and Follow-Up
10. Follow-Up
- Routine ophthalmologic monitoring
- Follow-up HIV testing and care if diagnosis is confirmed
- Monitor for progression or development of opportunistic infections (e.g., CMV retinitis)
11. Management (Key Points)
- HIV microangiopathy is the most common ocular manifestation of HIV
- Often asymptomatic
- Characterized by cotton wool spots at the posterior pole
- Results from retinal microvascular ischemia
- Improves with effective antiretrovirus
