Herpes simplex viral cytopathic effect in urine cytology

Abstract

Rarely are the viral cytopathic characteristic effects of herpes simplex virus (HSV) encountered in urinary cytopathology (Fig. C-1). In voided urine, such morphology is often attributed to an infection of the external genitalia. In the absence of cutaneous manifestations, however, diagnosis of HSV related pathology can suggest asymptomatic viral shedding and can potentially alert clinicians to the rarer manifestations of HSV urethritis 1,2 and HSV cystitis 3–5 . Presentations of the latter may run the gamut from an unsuspected cause of dysuria or urinary retention to life-threatening hemorrhagic cystitis in an immunocompromised host. 4,5 We present a rare finding of cellular changes consistent with HSV infection in a catheterized urine specimen collected from a 74-year-old woman with hematuria. The patient, who had a history of chronic obstructive pulmonary disease, was presented to the emergency department with dyspnea and was treated for community acquired pneumonia. Over the course of her hospitalization, she developed respiratory failure and required mechanical ventilation with steroid pulse therapy. She subsequently developed hematuria. Urine bacterial cultures were negative and microscopic examination of a catheterized urine specimen revealed frequent atypical urothelial cells amidst a background of acute inflammation and abundant erythrocytes. The abnormal cells exhibited enlarged, ground