Uvea: immune recovery uveitis: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Uvea: immune recovery uveitis

Sample item

A man with AIDS and treated CMV retinitis starts antiretroviral therapy, and his CD4 count rises from 40 to 250. Three months later he has new vitritis and macular oedema although the retinitis remains inactive. What is the cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Immune recovery uveitis

When immune function recovers, inflammation against residual viral antigen can cause vitritis, macular oedema and epiretinal membrane despite inactive retinitis. It is treated with local steroids, and antiviral therapy is continued while the count is low.

Option by option

  • A. Toxoplasma retinochoroiditis

    Toxoplasma retinochoroiditis shows a focal necrotic lesion next to an old scar.

  • B. Ganciclovir toxicity

    Ganciclovir toxicity affects the marrow and does not cause vitritis and macular oedema.

  • C. Relapse of cytomegalovirus retinitis

    Relapse would show an active advancing border of retinitis, which is not seen here.

  • D. Immune recovery uveitis (correct)

    Correct. Inflammation after immune reconstitution in an eye with inactive retinitis is immune recovery uveitis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is D, Immune recovery uveitis. When immune function recovers, inflammation against residual viral antigen can cause vitritis, macular oedema and epiretinal membrane despite inactive retinitis.

Why is "Toxoplasma retinochoroiditis" not the answer?

Toxoplasma retinochoroiditis shows a focal necrotic lesion next to an old scar.

Why is "Ganciclovir toxicity" not the answer?

Ganciclovir toxicity affects the marrow and does not cause vitritis and macular oedema.

Why is "Relapse of cytomegalovirus retinitis" not the answer?

Relapse would show an active advancing border of retinitis, which is not seen here.

What concept does this question test?

It tests Uvea: immune recovery uveitis in Ophthalmology. It is treated with local steroids, and antiviral therapy is continued while the count is low.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Uvea: immune recovery uveitis?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.