Normal or diffuse interstitial infiltrates. Rule out cotton-wool spots if CMV retinitis suspected. Ophthalmic exam with dilatation is diagnostic for CMV chorioretinitis CMV in other sites must be documented by BAL, visualization with endoscopy, or tissue biopsy. Consider LP with CMV PCR if myelopathy is suspected. Since brain biopsy is the only confirmatory procedure for diagnosis of CMV encephalitis, diagnosis is made by exclusion.
Brain biopsy is indicated in the patient with an encephalitis-like picture.
CMV serology is not helpful. Those with GI disease should also see dietician to prevent weight loss. Its use in other CMV-related disease is less well known. Place an indwelling longterm venous access. Oral Ganciclovir, 1000mg TID with food, after induction is completed and retinitis is stable.