WBR1077

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. The patient is started on Foscarnet , what should be used for the maintenance therapy ?]]
Answer A	AnswerA::Switch to Valganciclovir
Answer A Explanation	AnswerAExp::After treating the patient with ganciclovir or foscarnet the patient should be started on valganciclovir for maintenance therapy.
Answer B	AnswerB::Add Valganciclovir to foscarnet
Answer B Explanation	AnswerBExp::Valganciclovir is never used as an adjuvant. It is always used as a single therapy.
Answer C	AnswerC::Switch to HAART
Answer C Explanation	AnswerCExp::HAART is never used alone for maintenance of CMV retinitis. It may be used later in addition to valganciclovir for the treatment of HIV.
Answer D	AnswerD::Add HAART to foscarnet
Answer D Explanation	AnswerDExp::HAART can be added to foscarnet for the treatment of CMV retinitis with HIV. HAART is not used for the maintenance therapy of CMV Retinitis.
Answer E	AnswerE::Ganciclovir with steroids
Answer E Explanation	AnswerEExp::There is no role of steroids in the maintenance therapy of CMV retinitis
Right Answer	RightAnswer::A
Explanation	[[Explanation::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. The systemic use of corticosteroids has recently been implicated as elevating the risk of CMV in AIDS patients.The first report of CMV retinitis in a patient with dermatomyositis was recently published. Educational Objective After treating the patient with ganciclovir or foscarnet the patient should be started on valganciclovir for maintenance therapy. Reference Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::CMV, WBRKeyword::CMV retinitis, WBRKeyword::AIDS, WBRKeyword::HIV
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::