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https://upload.medbullets.com/topic/121870/images/cmv_retinitis.jpg
Snapshot
  • A 38-year-old man presents to the emergency department with worsening vision loss. His symptoms are accompanied by floaters and episodes of photopsia. Medical history is significant for HIV infection, which he has been nonadherent to his antiretroviral therapy. His CD4+ count is 45/mm3. Dilated fundoscopic examination demonstrates a white, granular retinal lesion. 
Introduction
  • Overview
    • opportunistic infection of the retina caused by cytomegalovirus (CMV)
      • usually seen in acquired immune deficiency syndrome (AIDS) and other immunocompromised states
  • Epidemiology
    • risk factors
      • AIDS
        • CD4 counts < 50/mm3
  • Pathogenesis
    • CMV hematogenously spreads to the retina and infects the vascular endothelium
  • Prognosis
    • improved with antiretroviral therapy
Presentation
  •  Symptoms
    • may be asymptomatic
    • decreased visual acuity
    • floaters
    • photopsia or scotomas in some cases
  • Physical exam
    • whitish, granular retinal appearance  
    • enlarged cotton wool spots
Differential
  • HIV retinopathy
    • differentiating factors
      • intraretinal hemorrhages
      • cotton wool spots
      • microaneurysms
Treatment
  •  Medical
    • intravitreal ganciclovir or foscarnet with systemic CMV therapy
      • indication
        • sight-threatening CMV retinitis
    • oral valgancyclovir
      • indication
        • non-sight-threatening CMV retinitis
Complications
  • Rhegmatogenous retinal detachment

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Questions (1)

(M2.OP.16.4691) A 55-year-old man comes into your office for an eye exam. The patient states he has had some trouble seeing over the last few weeks. He denies a history of pain. He has a history of HIV. He states that he was diagnosed with HIV about 20 years ago due to his intravenous drug usage. He has not used any drugs in the past 10 years, but states he also does not take his medications. His last CD4+ count (6 months ago) was 42. His vitals are normal and Figure A shows his fundoscopic exam. On eye exam, the patient has both some central and peripheral vision loss. What is the most likely diagnosis?

QID: 107637
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Retinal vein occlusion

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Retinal detachment

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Acute angle closure glaucoma

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CMV retinitis

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HSV retinitis

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M 6 E

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