A 38-year-old HIV-positive man with a CD4 count of 35 cells/microliter reports floaters and decreased vision in the right eye. Fundoscopy shows yellow-white granular areas of full-thickness retinal necrosis along vascular arcades, accompanied by intraretinal hemorrhages and vessel sheathing, with minimal vitritis. First-line systemic treatment is:

• A Intravenous acyclovir
• B Intravenous plus intravitreal ganciclovir ✓
• C Oral fluconazole
• D Intravenous penicillin G

Explanation

The fundus picture of granular necrotizing retinitis with hemorrhagic necrosis spreading along vessels in a patient with CD4 count below 50 is classic cytomegalovirus retinitis, the most common opportunistic ocular infection in AIDS. Induction therapy combines intravenous ganciclovir or foscarnet with adjunctive intravitreal ganciclovir injections, followed by maintenance therapy until immune recovery on antiretrovirals raises the CD4 count above 100. Acyclovir treats herpetic retinitis and has poor activity against CMV.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.