Vesicovaginal fistula associated with cytomegalovirus infection in an HIV-infected patient.
BACKGROUND
Cytomegalovirus (CMV) can cause multisystem disease in human immunodeficiency virus (HIV)-infected patients. An association with a vesicovaginal fistula has not previously been reported.


METHODS
An HIV-infected African-American female presented with back pain, swelling and paralysis of her lower extremities and continuous leakage of urine. Fundoscopic examination was typical of CMV retinitis. Doppler and CT studies showed bilateral deep vein thrombosis and bilateral pulmonary emboli, respectively. Anticoagulant therapy was started, and a Greenfield filter was placed. An examination under anesthesia and cystoscopy showed extensive vulvar and rectal condylomata, a large, necrotic, anterior vaginal mass, and a large vesicovaginal fistula. All necrotic tissue was resected and the biopsies taken identified CMV cytopathic effect.


CONCLUSIONS
Vesicovaginal fistula in an immunocompromised individual may be a local manifestation of systemic CMV disease.
Awonuga
Awoniyi
A
Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA. niyiawonuga@aol.com
Greenbaum
Laura
L
Merhi
Zaher
Z
Levgur
Michael
M
Minkoff
Howard
H
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000276:immunology; D000328:Adult; D003586:Cytomegalovirus Infections / Q000150:complications*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology; D006801:Humans; D014719:Vesicovaginal Fistula / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery