Unusual eye lesions should be warning sign for possibility of HIV, suggests case report

A case involving a rare pre-cancerous eye lesion in an HIV-positive women is reported by Scottish doctors in the February 18^th edition of AIDS. The doctors recommend that doctors should consider the possibility of HIV infection in all young people presenting with atypical conjuctival lesions.

Conjunctival intraepithelial neoplasia (CIN) is a rare pre-cancerous lesion affecting the surface of the eye. It traditionally affects elderly men, but there have been an increasing number of case reports of the lesion in young HIV-positive Africans.

A 38 year old Zambian woman was referred for counselling and HIV testing after her husband of 22 years presented for medical care with an AIDS-defining illness. She had a five-year history of a slowly increasing conjunctival lesion in her left eye, which doctors in Zambia had told her was benign. On examination she was found to have oral thrush.

She tested HIV-positive, and had a CD4 cell count of 143 cells/mm³ and a viral load of 13,400 copies/ml. She immediately started HAART and was given fluconazole to treat her oral thrush.

The lesion in the woman’s left eye was surgically removed and sent for analysis which indicated CIN, and she received two three-week cycles of topical chemotherapy, which was well tolerated. She also responded well to HAART, her CD4 cell count increasing to 369 cells/mm³ and her viral load fell to an undetectable level.

CIN, previously known as Bowen’s disease, is the most common tumour affecting the surface of the eye. Nevertheless it is rare, affecting between one and three individuals per 100,000 per year. Risk factors for CIN include solar ultraviolet light, petroleum products, heavy cigarette smoking, and infection with certain strains of human papilloma virus. It traditionally affects older men, but it has been diagnosed with increasing frequency in younger African HIV-positive individuals.

“This case report adds to the growing body of literature suggesting an association between HIV infection and CIN”, write the investigators. They recommend that doctors should consider the possibility of HIV infection in all young patients presenting with an unusual lesion on their eye.