A clinicopathologic report of the retinal lesions associated with didanosine
S. M. Whitcup, K. Dastgheib, R. B. Nussenblatt, R. C. Walton, P. A. Pizzo and C. C. Chan
National Eye Institute, National Institutes of Health, Bethesda, Md.
Didanosine, a purine analogue with antiretroviral activity, is used in the
treatment of human immunodeficiency virus disease. Associated toxic effects
of didanosine include pancreatitis, peripheral neuropathy, and retinopathy.
The retinal lesions associated with didanosine therapy were studied in a
6-year-old girl with acquired immunodeficiency syndrome. Gross examination
disclosed multiple well-circumscribed depigmented lesions in the
midperipheral retina. Microscopic examination of these lesions showed
multiple areas of retinal pigment epithelial (RPE) loss, some surrounded by
areas of hypertrophy or hypopigmentation of the RPE. Partial loss of the
choriocapillaris and neurosensory retina were also noted in areas of
diseased RPE. Transmission electron microscopy showed numerous membranous
lamellar inclusions and cytoplasmic bodies in the RPE cells. These data
show that didanosine primarily affects the RPE and that the
choriocapillaris and overlying neurosensory retina are also dystrophic in
areas of RPE loss.
