Acute cytomegalovirus prostatitis in AIDS

A Mastroianni, O Coronado, R Manfredi, F Chiodo, P Scarani
1996 Sexually Transmitted Infections  
Letters to the Editor CD4 lymphocyte count which was 277/mm3 at the time of diagnosis. He was evaluated by two ophthalmologists, both of whom confirmed CMV retinitis with a retinal detachment. In addition he had a vitreal biopsy which was positive by PCR for CMV and negative for herpes simplex, herpes zoster and Toxoplasma gondii. His retinitis failed to respond to intravenous genciclovir, but subsequently responded to induction with 3 weeks of intravenous foscamet therapy and remains quiescent
more » ... on IV foscamet maintenance therapy. Following diagnosis of CMV infection his CD4 count fell to 90/mm3 within 6 months, although it improved with combination antiretroviral therapy (zidovudine and zalcitabine). Interestingly, in two of the other non-splenectomised patients CD4 counts fell precipitously soon after diagnosis (from 255/mm3 to 15/mm3 over 8 months in one patient and 235/mm3 to 32/mm3 over 7 months in the other) reinforcing the importance of aggressive antiretroviral therapy once an opportunistic infection associated with immunocompromise develops. A non HIV related case with a normal CD4 count has highlighted the importance of CD4 cell function in the prevention of CMV retinal infection.5 HIV infection causes a great heterogeneity of immunological dysfunction. The CD4 count acts as a surrogate marker for the level of immune dysfunction but may hide functional as well as other subtle abnormalities of the immune system. CD4 counts are useful for predicting patients at risk of CMV retinitis and, therefore, those who may benefit from screening. However, although rare, this case further demonstrates that CMV retinitis can occur at CD4 counts greater than 200/mm3 and should serve to caution HIV physicians that the diagnosis of CMV retinitis is not excluded by a relatively high CD4 count. Ophthalmol 1995;79:962-3. 4 Concorde coordinating committee. Concorde: MRC/ ANRS randomised double-blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Lancet 1994;343:871-80. 5 Angus BJ, Green ST, McKinley JJ. McMenamin J, Walker E. HIV-associated CMV retinitis occurring in the setting of a high CD4 count: what about AIDS definitions? IntJ Acute cytomegalovirus prostatitis in AIDS Genitourinary tract disorders are common in the acquired immunodeficiency syndrome (AIDS) including a wide spectrum of abnor-malities due to an AIDS-related neoplasm or infection due to typical microorganisms or opportunistic pathogens.' Recent papers have emphasised the importance of prostatic disease as an emerging problem for patients with HIV infection. Indeed, involvement of prostatic gland is becoming more prevalent in patients with AIDS than in the general population.2 Several clinical and pathologic surveys have described cases of prostatic disease caused by typical bacteria, including Escherichia coli and other Gram-negative bacteria, Staphylococcus aureus, Haemophilus parainfluenzae and Salmonella typhi, Mycobacterium tuberculosis and atypical mycobacteria, and fungal pathogens such as Histoplasma capsulatum and Cryptococcus neoformans.2 HIV itself alone, in the absence of other infecting agents, also has been implicated as a cause of prostatic abnormalities.2 In the current literature we rarely find reports of prostatitis caused by cytomegalovirus (CMV) in HIV-positive persons. ' We here report a rare case of prostatitis due to CMV infection in a patient with AIDS in whom the diagnosis was established after death and who received antiviral chemotherapy with ganciclovir. A 34 year old intravenous drug abuser with AIDS was hospitalised complaining of lower abdominal pain, urinary frequency without dysuria, and fever. Six months before he had came to our attention because of CMV retinitis that had been treated with ganciclovir with a successful response, but the patient had not continued with a maintenance therapy. At the moment of the admission he appeared severely ill. The laboratory studies revealed a CD4 + lymphocyte cells count below 50/pl, a white blood cells count (WBC) of 3400/mm3 with 60% neutrophils, and 18% lymphocytes, an erythrocyte sedimentation (ESR) rate of 78 mm/hour, and a lactate dehydrogenase (LDH) value of 650 U/l. Urinanalysis revealed one to five WBC per high power field without casts and trace amounts of protein. Repeated urine culture grew CMV. Microscopic and cultural examinations of blood, sputum and stool specimens were unremarkable. An ultrasound evaluation of the lower abdomen was normal. The examination of the prostate was normal. An active CMV retinitis in the right ocular fundus was detected. Reinduction therapy with ganciclovir was started in association with cotrimoxazole. The patient's clinical condition continued to deteriorate, and he died after two weeks of hospitalisation. Post mortem examination reported a disseminated CMV infection, with prominent localisation in the prostatic gland, the lungs and the adrenal glands. Macroscopic evaluation revealed a normal sized prostate, while microscopically there was evidence of a large inflamed prostatic epythelium with multiple areas of tissue necrosis containing CMV intranuclear and intracytoplasmatic inclusions. Although infection with CMV is commonly benign in the immunocompetent person, the virus remains a major cause of morbidity and 447 on 19 July 2018 by guest. Protected by copyright.
doi:10.1136/sti.72.6.447 fatcat:5z3myb543bgdpg7tztlt42liii