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Background: Anaphylaxis is a potentially fatal complication of fluorescein angiography. It is diagnosed by clinical signs. Serum beta-tryptase serves as a specific indicator of mast cell activation and of anaphylactic shock that can be detected by radioimmunoassay., Method: This is a report on a 48-year-old woman who developed anaphylaxis during fluorescein angiography. This study investigates the role of beta-tryptase in anaphylactic shock resulting from intravenous fluorescein angiogram., Results: A serum sample of beta-tryptase collected at the time of an adverse reaction to fluorescein angiography was determined by radioimmunassay to be elevated above 20 ng/ml (normal level <1 ng/ml). This indicates massive mast cell activation and anaphylactic shock., Conclusion: This case is the first in which elevated levels of beta-tryptase in serum indicated that the systemic adverse reaction to fluorescein was mast cell dependent. Additionally, beta-tryptase levels can be assayed to detect anaphylactic reactions several hours after a precipitating event.

Background: Anterior segment findings in AIDS patients presenting with cytomegalovirus (CMV) retinitis have not been specifically addressed in the American literature., Methods: Our study evaluated 21 AIDS patients with CMV retinitis., Results: Nineteen (90%) of these patients exhibited corneal endothelial deposits concurrent with CMV retinitis. The endothelial deposits were microscopic, opaque, linear flecks arranged in a reticular-like fashion. Of 42 eyes evaluated, 32 (76%) demonstrated active CMV retinitis. Corneal endothelial deposits were noted in 26 (81%) of the 32 eyes with retinitis. These corneal endothelial deposits were absent in the eyes which did not have CMV retinitis., Conclusion: Meticulous examination of the retina of an HIV-positive or AIDS patient who presents with reticularly arranged, linear, flecked corneal endothelial deposits should be performed to ensure that the diagnosis of CMV retinitis can be ruled out.

We report a patient with AIDS who developed rapidly progressive, acute outer retinal necrosis. Cytomegalovirus etiology was proposed as a possibility in view of the histopathologic identification of the virus in the fellow concomitantly affected eye. Treatment with ganciclovir resulted in disappearance of the posterior pole lesions and inactivation of the peripheral lesions. We suggest that ganciclovir be used as soon as this condition is suspected in order to optimize the outcome.