case_images: PMC11182273_01
case_images: Fundus photos from initial presentation shows active retinitis superiorly (A). Fluorescein angiography shows delayed perfusion and hypoperfusion of temporal retina (B) with mild hyperfluorescence of the disc in the late phases of the angiogram. The perfusion delay persists (C).
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case_images: Fluorescein angiography showed leakage near foci of retinitis superiorly, hyperfluorescence of the disc, and diffuse peripheral retinal ischemia ( Figure 1 ).
case_images: Plot showing the relationship between quantitative serum and anterior chamber CMV PCR values relative to the time from initial presentation.
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case_images: AC quantitative CMV PCR is shown in  Figure 2 . An aflibercept injection 2 mg/0.05 (Regeneron, Tarrytown, NY, USA) was administered seven weeks after initial presentation due to slightly increased retinal thickening on macular optical coherence tomography (mOCT) in  Figure 3 .
case_images: Macular optical coherence tomography (mOCT) images from the day of initial presentation (A) and 7 weeks following initial presentation prior to aflibercept injection where there is slight thickening of the macula due to intraretinal fluid (B).
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case_images: AC quantitative CMV PCR is shown in  Figure 2 . An aflibercept injection 2 mg/0.05 (Regeneron, Tarrytown, NY, USA) was administered seven weeks after initial presentation due to slightly increased retinal thickening on macular optical coherence tomography (mOCT) in  Figure 3 .
case_images: Fundus photos at 2 weeks following 3 intravitreal foscarnet injections shows improvement of the retinitis superiorly (A) with continued resolution at 1 month following a total of 5 intravitreal foscarnet injections (B). There is complete resolution of the retinitis with fibrosis superiorly and reduced retinal heme at 1-year follow-up (C).
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case_images: After nine months, valganciclovir was discontinued given his clinically stable retinal disease.  Figure 4  shows fundus photos from initial presentation to the most recent exam, two years following initial presentation.