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Updated October 14, 2007

Case 7: A 43-Year-Old with Visual Changes and Cytomegalovirus Retinitis

Authors: David H. Spach, MD Elaine L. Chuang, MD

A 43-year-old HIV-infected woman with a CD4 count of 22 cells/mm3 presents with new visual problems. She describes difficulty seeing out of her left eye and she has noticed many floaters in the same eye. Approximately 1-year prior, she was diagnosed with HIV infection and has refused to regularly engage in medical care for management of her HIV disease. She takes trimethoprim-sulfamethoxazole (Bactrim, Septra) for Pneumocystis pneumonia prophylaxis, but she takes no other medications and has never taken antiretroviral medications. On examination, she has obvious decreased visual acuity in her left eye. She is urgently referred to an ophthalmologist for evaluation of suspected cytomegalovirus (CMV) retinitis.

Which one of the following statements is TRUE related to CMV retinitis in HIV-infected patients?

A Cytomegalovirus (CMV) retinitis in HIV-infected patients usually results from reactivation disease in persons previously infected with CMV.
B In this situation, initiating antiretroviral therapy would be sufficient for treatment of the CMV retinitis. Specific therapy for CMV with valganciclovir (Valcyte) or a ganciclovir intraocular implant (Vitrasert) would not be necessary.
C The patient in this case history had unusual presenting manifestations for CMV retinitis. Most patients present with eye pain, conjunctival erythema, and visual loss.
D The diagnosis of CMV retinitis should be confirmed in all patients with suspected CMV retinitis by detecting CMV (using PCR-based techniques) in vitreous fluid.