A 34-year-old man with untreated HIV infection and CD4 count below 50 cells/mm3 presents with floaters in the right eye. Fundus shows fluffy white-yellow retinal necrosis with haemorrhage distributed along vascular arcades, classically described as 'pizza pie' appearance. First-line systemic treatment is:

• A Pyrimethamine and sulfadiazine
• B Intravenous acyclovir alone
• C Systemic corticosteroids with intravenous foscarnet
• D Oral valganciclovir induction followed by maintenance therapy ✓

Explanation

The picture is cytomegalovirus retinitis, the most common opportunistic ocular infection in advanced AIDS. Induction with oral valganciclovir (or IV ganciclovir) followed by maintenance until immune recovery with antiretroviral therapy is standard. Acyclovir is inadequate against CMV, pyrimethamine-sulfadiazine treats toxoplasmosis, and steroids would worsen viral replication.

Reference: American Academy of Ophthalmology Basic and Clinical Science Course, Section 9: Intraocular Inflammation and Uveitis, 2022-2023 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.