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IRU Presentation — SCE Infectious Diseases MCQ

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HardHIV MedicineIRU PresentationSCE Infectious Diseases

A 28-year-old man with HIV (CD4 200, just started ART 4 weeks ago) develops a painful red eye with reduced visual acuity. Slit-lamp shows anterior uveitis with mutton-fat keratic precipitates. Posterior segment shows vitritis. His CD4 was 50 before ART. What is the most likely diagnosis?

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Correct answer: A — Immune recovery uveitis (IRU) — inflammatory uveitis occurring during ART-induced immune reconstitution, often in the context of prior subclinical CMV retinitis

IRU occurs when immune reconstitution on ART triggers vitritis and anterior uveitis directed against residual CMV antigens in the retina from prior (often subclinical) CMV retinitis. It typically presents 4–12 weeks after ART initiation with visual symptoms (floaters, reduced acuity). Treatment is periocular or intravitreal corticosteroids (Dexamethasone or Triamcinolone). Systemic corticosteroids may be needed for bilateral/severe IRU. ART should continue. Cystoid macular oedema is a complication that can permanently reduce vision.

Reference: BHIVA 2022 – OI guidelines; AAO 2020 – IRU