CMV retinitis typically occurs in which patient population?

• A. Healthy children
• B. Elderly with macular degeneration
• C. Patients with diabetic retinopathy
• D. Immunocompromised individuals

Answer: (D)

CMV retinitis is an opportunistic infection that appears when the immune system, especially T-cell–mediated immunity, is severely weakened. The patient population most likely to develop it is immunocompromised individuals, most classically people with AIDS (often when CD4 counts fall well below 100 cells/µL, commonly under 50), but also including organ transplant recipients and patients on strong immunosuppressive therapy or chemotherapy. Clinically, it presents with visual changes such as floaters or progressive vision loss, and the fundoscopic exam shows necrotizing retinitis with retinal hemorrhages along the vessels, sometimes described as a “pizza pie” appearance. The infection reflects a failure of immune control over CMV, so healthy individuals without immunosuppression are not typically affected. This distinguishes it from conditions like macular degeneration in the elderly or diabetic retinopathy, which arise from age-related or metabolic vascular processes rather than CMV reactivation.