A 38-year-old HIV-positive man with a CD4 count of 35 cells/mm3 complains of floaters in the right eye. Fundoscopy shows granular yellow-white areas of full-thickness retinal necrosis along the vascular arcades with associated flame-shaped haemorrhages. What is the appropriate first-line induction therapy?

• A Weekly intravenous cidofovir with probenecid as sole therapy
• B High-dose oral acyclovir 800 mg five times daily
• C Topical ganciclovir ophthalmic gel five times daily
• D Oral valganciclovir 900 mg twice daily for 21 days followed by maintenance dosing ✓

Explanation

The picture of haemorrhagic necrotising retinitis along the arcades in a patient with CD4 below 50 cells/mm3 is cytomegalovirus retinitis. Induction uses oral valganciclovir 900 mg twice daily for about three weeks, then once daily maintenance until immune recovery on antiretroviral therapy. Acyclovir is the drug for acute retinal necrosis caused by VZV or HSV and has no useful activity against CMV, which kills the second option.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.