Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Cytomegalovirus (CMV) Retinitis


History of Present Illness

Cc : Weight loss over the past 3 months, with onset of floaters OU over the past 6 weeks

A 38-year-old man presents in the emergency department (ED) with blurred vision in the right eye (OD) and floaters in both eyes (OU) over the past 6 weeks. He is an artist who lost 24 pounds over the past 3 months and has complained of chronic watery stools since that time. He has no history of pain, photophobia, or redness in either eye.

Exam
OD OS
Visual acuity 20/80 20/25
Intraocular pressure (IOP) (mm Hg) 12 10
Lids/sclera/conjunctiva Purplish-red lesion on RLL, 0.5 mm diameter. Otherwise, within normal limits (WNL) ( Fig. 53.3 ) Clear. No injection
Cornea Clear with no keratic precipitate (KP) Clear with no KP
Anterior chamber (AC) No flare or cell No flare or cell
Iris Round pupil without posterior synechiae Round pupil without posterior synechiae
Lens Clear Clear
Vitreous cavity 0.5 vitreous cell 0.5 vitreous cell
Retina/optic nerve Swollen optic nerve head with peripapillary hemorrhage, vascular sheathing along arcades and macular edema ( Fig. 53.1 ) Central retinal granular opacities in atrophic retina surrounded by active border of retinitis in the peripheral retina progressing posteriorly ( Fig. 53.2 )

Fig. 53.1, OD: Optic nerve swelling with peripapillary hemorrhagic retinitis and white exudates extending along the vascular arcades with macular edema.

Fig. 53.2, OS: Granular active border of retinitis surrounding an atrophic retina.

Fig. 53.3, Purple-red vascular nodular skin lesion on right lower lid (RLL) diagnosed as Kaposi sarcoma.

Questions to Ask

  • Were you evaluated for your weight loss and watery stools? If so, what tests were done?

  • Have you participated in the use of intravenous (IV) drugs or unprotected sex with men or women?

  • Have you had any skin lesions on your face or body that have not regressed?

He was recently hospitalized in a community hospital for weight loss and frequent diarrhea. A colon biopsy was done, and he was told that he had an infection with a fungus, cryptococcosis, and was started on IV therapy with amphotericin and another drug. He was then sent to the ED. He has had unprotected sex with men, and he has had a little red nodule on the right lower lid for the past few months ( Fig. 53.3 ).

Assessment

  • Infectious retinitis, OU, presumably secondary to immune suppression

  • Cryptococcosis enteritis

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