Cytomegalovirus retinitis with a CD4+T cell count of 147.

1 of 2 DESCRIPTION A 34-year-old lady who defaulted highly active antiretroviral therapy (HAART), returned after 2 years with bilateral rapidly progressive blurring of vision of 6 months duration. Five months back she was diagnosed to have cerebral toxoplasmosis and was started on double strength trimethoprim/ sulphamethoxazole and HAART and she was continuing on the same regimen. Her CD4+T cell count was 147 (CD4+). Pupils were bilaterally dilated, sluggishly reacting to light. Visual acuity revealed perception of hand movements+ on the right eye and perception of light+ on the left eye. There was no focal neurological defi cits. CT scan of brain showed a healed granuloma on the right side. With a past history of cerebral toxoplasmosis and CD4+ 147 (reconfi rmed), the possibilities considered were toxoplasma choroidoretinitis or cytomegalovirus retinitis (CMV). But funduscopy revealed active retinitis bilaterally ( fi gure 1A,B ) with brush fi re appearance, haemorrhages, exudates, arteriolar attenuation with peri vascular sheathing and retinal oedema diagnostic of CMV retinitis( fi gure 2 ). Deterioration of vision ceased once the treatment was initiated on intravenous ganciclovir. Images in...