Abstract
Diagnosis: Cytomegalovirus appendicitis. The patient presented with symptoms and signs suggesting localized peritonitis. The clinical diagnosis of acute appendicitis prompted surgical intervention. On macroscopic examination, the appendix appeared congested, measuring 6 X 1 X 0.1 cm. Microscopic examination revealed ulcerated mucosa with luminal neutrophils. A lymphohistiocytic infiltrate was visible in the mucosa and submucosa, with preservation of the muscularis propria (figure 1). The inflammatory infiltrate featured many histiocytes and stromal cells containing nuclear and cytoplasmic inclusions characteristic of cytomegalovirus (CMV) infection (figure 2). Subsequent immunostaining confirmed the presence of CMV. Acid-fast staining was negative for mycobacteria. The result of a CMV antigen immunofluorescence (cytospin) assay was positive. The patient was treated with intravenous ganciclovir, and antiretroviral therapy was initiated. His fever resolved with ganciclovir therapy. HIV infection is frequently complicated by gastrointestinal diseases, which may be caused by a diverse range of infectious
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