Cytomegalovirus infection physical examination

The appearance of the patient depends on the stage of the disease. The patient may look very healthy or be ill-looking and cachectic. On fundus examination fluffy yellow-white retinal lesions, with or without intraretinal hemorrhages can be demonstrated in patients with CMV retinitis. Abdominal distension and tenderness can be present on examination in patients with CMV colitis. In patients with CMV encephalitis altered mental status and focal neurological deficits are present.

The appearance of the patient depends on the stage of the disease. The patient may look very healthy or be ill-looking and cachectic.^[1]

• Fever

• Tachycardia

• Hypotension

• Tachypnea

Eyes
On fundus examination the following findings can be demonstrated in patients with CMV retinitis:

• Fluffy yellow-white retinal lesions, with or without intraretinal hemorrhage.
• Inflammation of the vitreous can be demonstrated in patients with severe immunosuppression.
• Blood vessels appear sheathed.
• If left untreated, retinitis is a rapidly progressive condition and on fundus examination it demonstrates a characteristic brushfire pattern, with a granular, white leading edge advancing before an atrophic gliotic scar.

• Normal heart sounds
• No murmurs, gallops or rubs

• Crackles and rhonchi may be heard in patients with CMV pneumonitis.^[2]

• Abdominal tenderness
• Abdominal distension can be present on examination in patients with CMV colitis.^[3]

The following examination findings can be present in CMV encephalitis:

• Focal neurological deficits
• Altered mental status
• Hypotonia
• Normal or diminished deep tendon reflexes