Severe cytomegalovirus retinitis

Fig. 1 Widefield fundus imaging of OS cytomegalovirus retinitis.Widefield fundus imaging of OS showing florid haemorrhagic retinitis with macular involvement and diffuse vasculitis with frosted branch angiitis in a 34-year-old male patient.He developed significant visual deterioration in the left eye after 12 days of high-dose oral prednisolone initiated by his local unit for presumed sarcoid uveitis following presentation with haemorrhagic left optic disc swelling.His right eye was unaffected.Cytomegalovirus DNA was detected by aqueous fluid polymerase chain reaction, confirming a diagnosis of cytomegalovirus retinitis which was managed with intravitreal foscarnet and oral valganciclovir.Infectious blood screen revealed an underlying undiagnosed human immunodeficiency virus type 1 (HIV) infection.Visual acuity in his left eye further deteriorated to hand movements despite adequate response to treatment.This case highlights the importance of assessing HIV status and considering viral aetiologies prior to steroid initiation in the context of haemorrhagic disc swelling.