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Updated: Dec 15 2021

CMV Retinitis

Images
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
    • Pathogenesis
      • CMV hematogenously spreads to the retina and infects the vascular endothelium
  • 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
  • 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
  • Prognosis
    • Improved with antiretroviral therapy
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