Cytomegalovirus retinitis in a patient with human immunodeficiency virus: A clinical case study

Aims/Purpose: To present a clinical case of cytomegalovirus (CMV) retinitis in a patient with newly diagnosed HIV, highlighting the characteristic retinal appearance and treatment outcomes. Methods: A 52‐year‐old male with no significant medical history presented with weight loss and persistent diarrhea. Initial evaluation revealed HIV infection at AIDS stage C3, with a high viral load (2,330,000 copies/mL) and severe immunosuppression (CD4 count = 10 cells/μL). Additional findings included pancolitis, atypical pulmonary infiltrates, and pancytopenia. Ophthalmologic examination was conducted due to reported visual disturbances. Results: Ophthalmologic assessment revealed a visual acuity of 1.0 in both eyes and intraocular pressure of 10 mmHg. Fundoscopy and ultra‐wide field retinography identified lesions resembling a "cheese and tomato pizza" in the right eye, characterized by granular white‐yellow and white‐gray paravascular infiltrates, retinal opacification, and associated hemorrhages. Optical coherence tomography (OCT) showed foveal integrity but significant vitreous cellularity in the right eye and optic nerve edema. The patient was treated with Valganciclovir 900 mg every 12 hours for CMV, alongside a combination antiretroviral therapy (ART) regimen of Bictegravir, Emtricitabine, and Tenofovir, plus Atovaquone due to cotrimoxazole intolerance. Follow‐up examinations indicated a gradual improvement in retinal lesions, with the right eye showing residual peripheral nasal lesions and the left eye remaining clear. Conclusions: This case underscores the importance of early diagnosis and prompt initiation of antiviral and antiretroviral therapies in managing advanced opportunistic infections in HIV/AIDS patients. The "cheese and tomato pizza" analogy aids in the visual identification of CMV retinitis. Continuous monitoring and timely intervention are crucial for preserving vision and improving patient outcomes. References Basic and Clinical Science Course, Retina. American Academy of Ophthalmology. 2021 Diaz Llopis M. AIDS in Ophthalmology. Lecture 1996 Spanish Society of Ophthalmology (SEO)