[Emergency] Atlas of Cytomegalovirus Retinitis

These are pictures of Cytomegalovirus (CMV) Retinitis. This is a part in Fundoscopic findings of the Atlas of Emergency Medicine book

Clinical Summary

Patients may complain of the gradual and usually painless onset of the following visual sensations: floaters, scintillating scotomas (quivering blind spots), decreased peripheral visual field, and metamorphopsia (wavy distortion of vision). Cytomegalovirus (CMV) infiltrates appear as focal, small (but may be larger, confluent) white lesions in the retina that look like cotton wool spots. CMV is a necrotizing virus that is spread hematogenously, so that damage is concentrated in the retina adjacent to the major vessels and the optic disk. Often hemorrhage is involved with significant retinal necrosis (dirty white with a granular appearance), giving the “pizza pie” or “cheese and ketchup” appearance. Optic nerve involvement and retinal detachments can be present. 

The differential includes other infections such as toxoplasmosis, other herpesviruses, syphilis, and occasionally other opportunistic infections.

Management and Disposition

Reversal, if possible, of immunosuppression; antiviral agents have been used effectively to threat this condition.

Pearls

1. HIV retinopathy consists of scattered retinal hemorrhages and scattered, multiple cotton wool spots that resolve over time, whereas CMV lesions will typically progress.
2. Although exposure to the CMV virus is widespread, the virus rarely produces a clinically recognized disease in nonimmunosuppressed individuals. 

CMV Retinitis
FIGURE 3.24 CMV Retinitis. “Pizza pie” or “cheese and ketchup” 
appearance is demonstrated by hemorrhages and the dirty, white,

granular-appearing retinal necrosis adjacent to major vessels. 


REFERENCES
The Atlas of Emergency Medicine, Fourth Edition, 2016.

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CLINICAL ATLAS,118,DERMATOLOGY ATLAS,10,EMERGENCY ATLAS,44,HAEMATOLOGY ATLAS,23,HUMAN ANATOMY,1,MICROBIOLOGY ATLAS,66,PARASITOLOGY ATLAS,4,PATHOLOGY ATLAS,22,PEDIATRIC ATLAS,42,STDs,19,SUBCLINICAL ATLAS,116,
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Free Medical Atlas: [Emergency] Atlas of Cytomegalovirus Retinitis
[Emergency] Atlas of Cytomegalovirus Retinitis
These are pictures of Cytomegalovirus (CMV) Retinitis. This is a part in Fundoscopic findings of the Atlas of Emergency Medicine book
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