A 40-year-old Hispanic male with a history of HIV presents with blurred vision, flashes and floaters in both eyes for 1 week. Best-corrected visual acuity is 20/25 in the right eye and 20/30 in the left eye. Intraocular pressures are 9 in the right and 11 in the left eye. There is an afferent pupillary defect in the left eye. Confrontation visual fields are full in both eyes. Slit lamp exam shows fine keratic precipitates, rare cell and 1+ flare in both eyes. There is trace nuclear sclerosis and 1+ cell in the anterior vitreous in both eyes. Fundus photos are shown above.
most likely CMV retinitis . other DDX acute retinal necrosis or activation of old toxoplasmosis lesions
immunocompromised pt and those fundus changes are may be CMV retinitis. less likely to be acute retinal necrosis or activation of old lesions like toxoplasmosis becuse of clear vitreous
Discussed in the answer to Question number 1!
Very helpful DD. Thnx a lot
More thanks for sharing your knowledge with us. True online study.
The incidence of HIV infection is rising in the Philippines and I start getting patients for CMV screening. This exercise is very helpful. Unfortunately foscarnet is not available in my country.