WBR1076
| Author | PageAuthor::Chetan Lokhande |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | SubCategory::Infectious Disease, SubCategory::Ophthalmology |
| Prompt | [[Prompt::A 47-year-old man with five years history of AIDS complains of blurry vision. On CD4 examination the count is 44. The patient doesn't have any other complaints. A dilated eye exam shows necrotizing retinitis. What is the best treatment for this patient?]] |
| Answer A | AnswerA::HAART |
| Answer A Explanation | [[AnswerAExp::HAART is not indicated in the treatment of CMV retinitis. It is indicated for treatment of HIV . The patient has HIV since 5 years and doesn't have any other complaints. Hence HAART is not indicated now . It may be started in combination to treatment of CMV .]] |
| Answer B | AnswerB::Efavirenz |
| Answer B Explanation | [[AnswerBExp::Efavirenz is not indicated in the treatment of CMV retinitis. It is indicated for treatment of HIV . The patient has HIV since 5 years and doesn't have any other complaints. Hence Efavirenz is not indicated now . It may be started in combination to treatment of CMV .]] |
| Answer C | AnswerC::Zidovudine |
| Answer C Explanation | [[AnswerCExp::Zidovudine is not indicated in the treatment of CMV retinitis. It is indicated for treatment of HIV . The patient has HIV since 5 years and doesn't have any other complaints. Hence Zidovudine is not indicated now . It may be started in combination to treatment of CMV .]] |
| Answer D | AnswerD::Foscarnet |
| Answer D Explanation | AnswerDExp::Foscarnet is the second drug of choice for treatment of CMV retinitis . Since steroids are not indicated in AIDS foscarnet is the correct answer. |
| Answer E | AnswerE::Ganciclovir with steroids |
| Answer E Explanation | AnswerEExp::Ganciclovir is the drug of choice for treatment of CMV retinitis . Since steroids increase the risk of CMV retinitis they are not indicated here. As a result ganciclovir with steroids is not the correct answer. |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Cytomegalovirus (CMV) is the most common cause of HIV retinitis. CMV retinitis occurs when the CD4 count drops below 50. The most common sign on a dilated ophthalmic examination is necrotizing retinitis. Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the eye's retina that can lead to blindness. Cytomegalovirus (CMV)) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions. Such inclusions are called an "owl's eye" effect.
While CMV is found in almost everyone, and is usually fought off by the immune system, for people who are immunocompromised, by diseases, transplants, or chemotherapy the virus is not adequately destroyed and can cause damage to the eye and the rest of the body. HIV positive persons are most at risk, especially when the CD4 cell count decreases. CMV is a common virus that infects those who are HIV positive. It affects the eye in about 30% of the cases by causing damage to the retina. Symptoms can include blurred vision, eye pain, photophobia, redness, and blindness. It may affect just one eye at first, but then may spread to the other. Because the virus is so threatening to vision, it is usually treated by a vitreo-retinal surgeon, by antivirals such as ganciclovir or foscarnet, which can be taken orally, intravenously, injected directly into the eye (intravitreal injection), or through an intravitreal implant. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::HIV, WBRKeyword::AIDS, WBRKeyword::CMV, WBRKeyword::Retinitis |
| Linked Question | Linked::WBR1077 |
| Order in Linked Questions | LinkedOrder:: |