Cytomegalovirus infection differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Differential Diagnosis of Cytomegalovirus infection

Cytomegalovirus Retinitis

Cytomegalovirus retinitis must be differentiated from the following infectious causes of retinitis:

Infectious Agent	Clinical Manifestations
Cytomegalovirus	Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels. These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both. Further extending lesions may be present in close proximity to the vortex veins as well as the ora serrata.
Tuberculosis	Caseating granulomas Multiple choroidal tubercles- small grayish nodules located on the posterior pole of the eye Yellow necrotizing granulomas|
Fungal	Candida albicans Visibly hazy vitreous White circumscribed lesions Aspergillus fumigatus Yellow subretinal infiltrates Retinal infiltrates Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement Cryptococcus neoformans Yellowish-white lesions located on the fundus of the eye Mutton-fat keratic precipitates
Toxoplasmosis	Localized areas of infiltrate Active lesions are adjacent to initial scarring
Syphilis	Hemorrhagic areas Flare visible in anterior and posterior portions

Cytomegalovirus Colitis

The symptoms of colitis such as bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis: Cytomegalovirus colitis is diagnosed by demonstration of intranuclear inclusion bodies on colonic biopsy.

Diseases	History and Symptoms				Physical Examination				Laboratory findings
	Diarrhea	Rectal bleeding	Abdominal pain	Atopy	Dehydration	Fever	Hypotension	Malnutrition	Blood in stool (frank or occult)	Microorganism in stool	Pseudomembranes on endoscopy
Allergic Colitis	+	++	+	++					++
Chemical colitis	+	++	++		+	+			++		+
Infectious colitis	++	++	++		+++	+++	++	+	++	++	+
Radiation colitis	+	++	+		+			+	++
Ischemic colitis	+	+	++		+	+	+	+	++
Drug-induced colitis	+	+	++			+			++		+