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South African Medical Journal

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Hutchinson’s sign as a marker of ocular involvement in HIVpositive patients with herpes zoster ophthalmicus

M van Dyk, D Meyer Meyer

Abstract


Background. A positive Hutchinsonfs sign indicates an increased risk of ocular involvement in herpes zoster ophthalmicus (HZO). We examined the sensitivity of Hutchinsonfs sign as an indicator of ocular involvement in a consecutive series of patients presenting with HZO.
Methods. We conducted a descriptive observational prospective study of patients .18 years old presenting with HZO and consenting to pre- and post-test counselling and HIV and CD4 testing. A full ophthalmological examination focused on the extent of ocular involvement, and the presence of Hutchinsonfs sign was confirmed by two clinicians.
Results. Thirty-three patients were enrolled; 29 were HIV positive, of whom 18 (62%) had not been diagnosed with HIV prior to enrolment. Of the 29 HIV-positive patients, 21 (72%) were Hutchinsonfs sign positive (HSP), all of whom had intra-ocular involvement (95% confidence interval 88 - 100%) Of the 8 HIV-positive, Hutchinsonfs sign-negative (HSN) patients, 4 did and 4 did not display intra-ocular involvement. Neither the mean CD4 count nor the average age in the HSP group differed significantly from the HSN group.
Conclusion. We confirmed that a Hutchinsonfs sign- and HIVpositive
patient with HZO has a very high positive predictive value for intra-ocular involvement. Neither age nor CD4 count had predictive value for ocular involvement. Young adults presenting with HZO should be suspected of having HIV, and HIV-positive patients with HZO but HSN may still have ocular involvement. All patients with HZO should be
seen by an ophthalmologist.



http://dx.doi.org/10.7196/SAMJ.3191
AJOL African Journals Online