A 32-year-old HIV-positive man (CD4 count 45 cells/μL, viral load detectable) presents with painless visual field loss in his right eye. Fundoscopy shows perivascular hemorrhages and exudates with a 'pizza-pie' or 'tomato-ketchup' appearance. What is the most likely diagnosis and treatment?
- A Cytomegalovirus (CMV) retinitis; IV or oral ganciclovir/valganciclovir ✓
- B Toxoplasma retinochoroiditis; sulfadiazine plus pyrimethamine
- C Cryptococcal chorioretinitis; IV amphotericin B
- D Syphilitic uveitis; IV penicillin G
Correct answer: A. Cytomegalovirus (CMV) retinitis; IV or oral ganciclovir/valganciclovir
Explanation
CMV retinitis is the most common serious ocular opportunistic infection in AIDS patients with CD4 < 50 cells/μL. The classic fundoscopic appearance is fluffy yellow-white retinal infiltrates with hemorrhage ('pizza-pie' appearance), often along retinal vessels. Valganciclovir (oral) is now the preferred induction and maintenance treatment; intravitreal ganciclovir implant is used for sight-threatening lesions. Antiretroviral therapy to restore immune function is essential to prevent relapse and progression.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.