Ophthalmology Series: Case 4

ANSWERS WILL BE POSTED IN REPLY BOX BELOW 18:00 (CET)

A 32 year old man has recently been tested positive for HIV. He presents to your clinic complaining of reduced vision and floaters. Examination of his retina shows white and hemorrhagic lesions.

Fundoscopy reveals:
Image result for slit lamp CMV retinitis

1. What is the most likely diagnosis in this patient ?

2. Describe the findings on fundoscopy

3. How would you confirm the diagnosis ?

4. How would you manage this patient ?

5. What complications may arise if left untreated ?

Source: https://www.ncbi.nlm.nih.gov/pubmed/27984023

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6 thoughts on “Ophthalmology Series: Case 4

  1. ANSWERS
    1. CMV Retinitis
    2. Microvascular occlusion causing retinal haemhorrage and cotton wool spots. . Fulminant – hemorrhagic necrosis on white/yellow cloudy retinal lesions. They may be centered around vasculature of what is described as ‘cottage cheese’ appearance.
    3. Polymerase chain reaction (PCR) of the vitreous or aqueous.
    4. The mainstay of treatment is ganciclovir and/or foscarnet given intravenously or into the vitreous. Management also requires HAART. If patients are on HAART, show healed lesion and two reports of CD4 6 months apart of > 100, they can be considered for discontinuation of CMV retinitis therapy. If all fails, opt for surgery which involves intravitreal placement of intraocular ganciclovir devices.
    5. Rhegmatogenous retinal detachments from breaks that occur near thin, necrotic retina if greater than 25% of the retina is involved.

    Liked by 1 person

  2. I like the clinical presentation. I am not sure in the average reader will feel comfortable with this information. It is important for you to decide what kind of reader your pursuing. Best of luck with the outcome.

    Like

  3. I admit I am still a beginner in all of this, and maybe I am susceptible to some mistakes. But I will try to explain myself as best I can.
    Mostly I am looking to interact with medical students and doctors all around the world. That is the audience I am looking for mostly. Now, we are not just about studying medicine, we also have thoughts on other aspects of life. So I created this platform for everyone to share their thoughts 🙂

    Liked by 1 person

  4. You may want to consider clinical cases that didn’t “fit the mold.” Cases that might have required solutions located “outside the box.” This would add some creativity as well as help clinicians correlate cases from a new perspective.

    Like

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