Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2018.029
Autopsy and Case Reports
Article / Autopsy Case Report

Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

Laís Braga Soares; Renata Buccheri; Renata Bacic Palhares; Amaro Nunes Duarte-Neto

Downloads: 1
Views: 1895

Abstract

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts. Patients with acquired immunodeficiency syndrome (AIDS) are at increased risk for CMV infection, and the most prevalent clinical manifestation is retinitis, followed by colitis, esophagitis, pneumonitis, and encephalitis. CMV oophoritis is poorly described in the literature with some cases reported in patients with hematological or solid malignancies, bone marrow or solid organ transplantation, immunosuppressive therapy, and advanced AIDS cases. We report the case of a 61-year-old woman with a recent diagnosis of AIDS, which was associated with a wasting syndrome. The patient presented with abdominal pain, headache, cutaneous vesicular lesions on the abdomen, anemia, lymphopenia, and hyponatremia; she died suddenly on the fourth day of hospitalization. The autopsy was performed and demonstrated disseminated CMV infection with hemorrhagic encephalitis as the immediate cause of death. Additionally, pneumonitis, extensive adrenalitis, ulcerated enteritis, focal hepatitis, and necrotizing oophoritis were found.

Keywords

Cytomegalovirus, Acquired Immunodeficiency Syndrome, Oophoritis, Autopsy

References

U. S. Department of Health and Human Services. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. USA: U. S. Department of Health and Human Services. Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents [cited 2018 Mar 5]. Available from: http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf

Albert MS, Amstey MS. CMV Oophoritis in an AIDS patient. Infect Dis Obstet Gynecol. 1995;3(5):202-4. [https://doi.org/10.1155/S1064744995000627]. [PMID:18472892]

Subietas A, Deppisch LM, Astarloa J. Cytomegalovirus oophoritis: ovarian cortical necrosis. Hum Pathol. 1977;8(3):285-92. [https://doi.org/10.1016/S0046-8177(77)80025-7]. [PMID:192660]

Manfredi R, Alampi G, Talo S, Calza RML, Tadolini M, Martinelli GN. Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease. Int J STD AIDS. 2000;11(6):410-2. [https://doi.org/10.1258/0956462001916001]. [PMID:10872916]

Friedmann W, Schäfer A, Kretschmer R, Lobeck H. Disseminated Cytomegalovirus Infection of the female genital tract. Gynecol Obstet Invest. 1991;31(1):56-7. [https://doi.org/10.1159/000293102]. [PMID:1849111]

Evans DJ, Lampert IA. Ovarian involvement by cytomegalovirus. Hum Pathol. 1978;9(1):122. [https://doi.org/10.1016/S0046-8177(78)80016-1]. [PMID:204571]

LiVolsi VA, Merino MJ. Cytomegalovirus infection of ovarian thecoma. Arch Pathol Lab Med. 1979;103(12):653-4. [PMID:228631].

Iwasaki T, Sakuma T, Satodate R, Takano N, Sata T, Kurata T. Cytomegalovirus oophoritis with cortical necrosis during remission of acute lymphocytic leukemia. Acta Pathol Jpn. 1988;38(8):1069-76. [PMID:2847481]

Ribaux C, Gloor E. Necrotic oophoritis due to cytomegalovirus. Schweiz Med Wochenschr. 1988;119(5):160-3. [PMID:2853451]

Williams DJ, Connor P, Ironside JW. Pre-menopausal cytomegalovirus oophoritis. Histopathology. 1990;16(4):405-7. [https://doi.org/10.1111/j.1365-2559.1990.tb01150.x]. [PMID:2163353]

Familiari U, Larocca LM, Tamburrini E, Antinori A, Ortona L, Capelll A. Premenopausal cytomegalovirus oophoritis in a patient with AIDS. AIDS. 1991;5(4):458-9. [https://doi.org/10.1097/00002030-199104000-00019]. [PMID:1647792]

Sharma TM, Nadasdy T, Leech RW, Kingma DW, Johnson LD, Hanson-Painton O. In situ DNA hybridization study of ‘primary’ cytomegalovirus (CMV) oophoritis. Acta Obstet Gynecol Scand. 1994;73(5):429-31. [https://doi.org/10.3109/00016349409006258]. [PMID:8009978]

Wales NM, Nordin AJ, Newell AN, Smith JR, Barton SE, Nelson MR. Cytomegalovirus infection in the genital tract of HIV-seropositive women. AIDS. 1996;10(7):802-3. [https://doi.org/10.1097/00002030-199606001-00023]. [PMID:8805880]

Ortiz-Rey JA, Touza F, Perez-Valcarcel J, Pérez-Villanueva J. Oophoritis due to cytomegalovirus in a female AIDS patient. Med Clin (Barc). 1997;108(9):357-8. [PMID:9139162]

Nieto Y, Ross M, Gianani R, et al. Post-mortem incidental finding of cytomegalovirus oophoritis after an allogeneic stem cell transplant. Bone Marrow Transplant. 1999;23(12):1323-4. [https://doi.org/10.1038/sj.bmt.1701797]. [PMID:10414924]

Yu J, Solano FX Jr, Seethala RR. Bilateral cytomegalovirus (CMV) oophoritis mimicking widely metastatic carcinoma: a case report and review of the literature. Diagn Pathol. 2007;2(1):50. [https://doi.org/10.1186/1746-1596-2-50]. [PMID:18096056]

Irsai G, Tampu-Kiss T, Dezso B, Miltényi Z, Illés A, Méhes G. Complications of systemic cytomegalovirus infection in therapy-resistant Hodgkin’s lymphoma. Orv Hetil. 2012;153(19):751-5. [https://doi.org/10.1556/OH.2012.29364]. [PMID:22564287]

Shen CY, Chang SF, Lin HJ, et al. Cervical cytomegalovirus infection in prostitutes and in women attending a sexually transmitted disease clinic. J Med Virol. 1994;43(4):362-6. [https://doi.org/10.1002/jmv.1890430408]. [PMID:7964646]

Fpathfu WAR, Nausheen Y, Fpathkfu RA, Khudairi AA, Nemenqani D. Histopathological features of na incidental case of cytomegalovirus salpingitis in a patient with inflammatory bowel disease. J Pak Med Assoc. 2013;63(6):780-3. [PMID:23901687]

Hall WW, Farmer PM, Takahashi H, Tanaka S, Furuta Y, Nagashima K. Pathological features of virus infections of the central nervous system (CNS) in the acquired immunodeficiency syndrome (AIDS). Acta Pathol Jpn. 1991;41(3):172-81. [PMID:1648857]

Bournérias I, Boisnic S, Patey O, et al. Unusual cutaneous cytomegalovirus involvement in patients with acquired immunodeficiency syndrome. Arch Dermatol. 1989;125(9):1243-6. [https://doi.org/10.1001/archderm.1989.01670210081012]. [PMID:2549883]

Macher AM, Reichert CM, Straus SE, et al. Death in the AIDS patient: role of cytomegalovirus. N Engl J Med. 1983;309(23):1454. [https://doi.org/10.1056/NEJM198312083092311]. [PMID:6314141]

Pulakhandam U, Dincsoy HP. Cytomegaloviral adrenalitis and adrenal insufficiency in AIDS. Am J Clin Pathol. 1990;93(5):651-6. [https://doi.org/10.1093/ajcp/93.5.651]. [PMID:2158225]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Publication date:
07/30/2018

5b5f02340e8825096050c2b2 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections