A 45-year-old man with HIV infection presents to the emergency department with a 2-week history of progressive visual loss, floaters, and photopsia in his right eye. He denies eye pain or photophobia. He has not been on antiretroviral therapy. On examination, vital signs are stable. Dilated funduscopic examination reveals multiple intraretinal hemorrhages and granular infiltrates along the distribution of blood vessels in the peripheral retina with a granular, hemorrhagic appearance. The anterior chamber is quiet with no signs of uveitis. Laboratory studies show a CD4+ count of 32 cells/μL and HIV RNA level of 850,000 copies/mL. Which of the following is the most likely diagnosis?
- A)Acute retinal necrosis due to herpes simplex virus
- B)Cytomegalovirus retinitis (hemorrhagic form)GABARITO
- C)Toxoplasma gondii retinochoroiditis
- D)Progressive outer retinal necrosis due to varicella-zoster virus
- E)Herpes zoster ophthalmicus with acute retinal necrosis
Explicação
CMV retinitis presenting as the hemorrhagic (fulminant) form is the most common viral retinitis in patients with severe immunosuppression (CD4 <50 cells/μL). The classic ophthalmologic findings include intraretinal hemorrhages mixed with granular infiltrates f... Ver explicação completa e trilha adaptativa →