September 29, 2014
A 33-year-old Hispanic man with HIV, presenting to the emergency department for increasing weakness, lethargy, diarrhea, abdominal pain, and blindness for the past few weeks
Cytomegalovirus-Associated Ventriculitis and Chorioretinitis
- Radiographic findings of opportunistic cytomegalovirus (CMV) ventriculoencephalitis in the adult population are nonspecific.
- CMV retinitis and gastrointestinal tract involvement are common forms of CMV infection, but neurological manifestations appear in fewer than 1% of all patients with CMV infection.
- Clinical Presentation: Confusion, disorientation, apathy, withdrawal, cranial neuropathies, and nystagmus
- Ventriculoencephalitis is the most common form of CNS involvement in CMV infection and is characterized by ependymitis along the inner surface of ventricles.
- CMV-induced retinitis occurs in approximately one-third of patients with AIDS who are not receiving HAART, and accounts for more than 90% of cases of blindness related to HIV infection.
- Key Diagnostic Features:
- Diffusion restriction along the ependymal surface with/without contrast enhancement.
- Chorioretinitis manifests as uveal enhancement, retinal detachment, and calcifications in the retina.
- CMV-induced retinitis begins most commonly in one eye and progresses to involve the contralateral eye.
- Occasionally, findings related to cytotoxic edema from perivascular cuffing and thrombus formation can be seen.
- DDx:
- Lymphoma
- Pyogenic ventriculitis
- Rx: Antivirals. Without Rx, CMV-induced retinitis causes permanent blindness in most patients within 3–6 months.
