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

Laís Braga Soares,Amaro Nunes Duarte-Neto,Renata Bacic Palhares,Renata De Oliveira Bucheri

doi:10.4322/acr.2018.029

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.

Highlights

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts
The main pathological finding at autopsy was disseminated cytomegalovirus (CMV) infection associated with acquired immunodeficiency syndrome (AIDS), which affected the brain, lungs, small intestine, liver, adrenals, ovaries, and skin
We considered that the ovarian involvement in the present case was secondary to the systemic infection and was not a primary CMV infection of the genital tract of the patient due to local reactivation or sexual transmission, since (i) there were no complaints and alterations in the physical examination related to the genitalia; (ii) in the post-mortem exam, the uterus had macroscopic and microscopic normal aspects compatible with the patient’s age; and (iii) the CMV lesions were more severe in the adrenal, brain, and intestines, which suggested systemic disease

Summary

Introduction

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. 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. A previously healthy 61-year-old woman presented with a 2-week history of severe abdominal pain associated with cutaneous vesicular lesions on the abdomen, significant weight loss, decreased visual acuity, and pulsatile occipital headache. The patient was referred to an infectious disease hospital. The patient had an acute and severe headache, followed by sudden cardiorespiratory arrest, which was unresponsive to all maneuvers of advanced cardiac life support.

Results

Discussion

Conclusion