32/M w poorly controlled HIV 2/2 ART nonadherence, p/w 7 d of L eye blurring of vision a/w central scotoma, photopsia & floaters. Denies fever, SOB, cough. Vitals stable. CD4 35 and VL 1 M one month ago. Labs: leucopenia. CMV retinitis suspected. Best way to diagnose? #IDMedEd
1/3) Answer: urgent ophthalmologic exam. Retinitis: most common form of CMV disease in HIV+ w/ CD4 <50. Presence of either photopsia (flashes of light similar to welding sparks) or floater is highly indicative of CMV retinitis and should be asked on history. #IDMedEd #HIVMedEd
2/3) Dx: expert ophtho exam of a dilated pupil (white fluffy spots with hemorrhages, so called "ketchup and cottage cheese" appearance). Negative blood CMV PCR/serology does not R/O CMV disease (only 70% w/ viremia & can have viremia w/o evidence of CMV disease). #IDMedEd
3/3) Urgent ophtho exam important; lesions typically progress 10-21 days after onset; the closer the lesions to the fovea, the faster, more sight-threatening (requires urgent intraocular and systemic ganciclovir/ valganciclovir). Peripheral lesions only require systemic antiviral
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