CMV retinitis is most commonly seen in AIDS patients when CD4 counts fall below 50 cells/µL; which lesion is most characteristic?

• A. Esophagitis
• B. Gastroenteritis
• C. Pneumonitis
• D. Retinitis

Answer: (D)

In advanced AIDS, CMV reactivation most characteristically targets the retina when the CD4 count drops below 50. The lesion you’re looking for is necrotizing CMV retinitis: areas of retinal whitening with hemorrhages along the retinal vessels, producing a distinctive appearance often described as a “pizza pie” or Cream-and-Ketchup pattern. Patients may notice floaters or vision loss, and the fundoscopic exam reveals these fluffy white lesions with vascular involvement. While CMV can cause esophagitis, gastroenteritis, or pneumonitis in this setting, those manifestations don’t produce the retinal lesion that is most characteristic here.