Pizza Pie Appearance of Retina on fundoscopy in an HIV infected patient suggests probable diagnosis of CMV Retinitis. The Histolpathological slide from the Upper GI Endoscopy biospy specimen shows presence of large (cytomegalic) cells with Owl&;s eye appearance. This appearance is typical of CMV infection. Pizza Pie Appearance of Retina on fundoscopy in an HIV infected patient suggests CMV Cytomegalovirus retinitis is the single most common oppounistic ocular infection seen in immunocompromised patients including those affected with HIV CMV retinitis in HIV patients is characterized by haemorrhage and necrosis in a perivascular distribution, with loss of fundal details, giving it the classical &;Pizza Pie&; Appearance This appearance is also termed as "Cheese and ketchup" appearance. Owl&;s eye Appearance from Intranuclear Inclusions in Biopsy Specimen suggests CMV infection Cells infected with CMV are two to four times larger than surrounding cells (cytomegalic) in vivo and often contain an 8- to 10- micromts intranuclear basophilic (or amphophilic ) inclusion body that is eccentrically placed and is surrounded by a clear peripheral halo, producing an "owl eye" appearance (sometimes called Bull&;s eye appearance) Smaller inclusions may also be demostrated in the cytoplasm occasionally (Typically basophillic and smaller) Cytomegalic cells are found in a wide variety of organs, including the salivary glands, lung, liver, kidney, intestine, pancreas, adrenal gland and central nervous system. Virus Inclusion Description Cytomegalovirus (CMV) Cowdry type A Intranuclear Basophilic (or Amphophilic) inclusions surrounded by a halo and by marginated chromatin Intracytoplasmic Inclusions consists of clusters of small granular basophilic bodies of various sizes Ref: Harrison&;s 19th edition Pgno: 1191