title: Cytomegalovirus pseudotumor of the duodenum in a patient with AIDS: an unrecognized and potentially treatable clinical entity.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is a common pathogen affecting the gastrointestinal tract in patients with AIDS. We report a case of CMV-induced pseudotumor of the duodenum in a patient with AIDS and review other reported cases of CMV-induced pseudotumors in the gastrointestinal tract. CMV-induced pseudotumor in patients with AIDS is an exceptionally rare clinical entity, and to our knowledge no reports have previously summarized this clinical entity.
  
  
  METHODS
  All previous cases included in our literature review were found using a PubMed search (1980-November 2008) of the English-language medical literature applying the terms 'CMV infection', 'inflammatory mass', 'pseudotumor', and 'gastrointestinal tract'. The references cited in these articles were examined to identify additional reports.
  
  
  RESULTS
  Although CMV-induced duodenitis has been described in patients with HIV infection, to our knowledge CMV-induced pseudotumor of the duodenum has not been previously reported in the literature. We describe the first case of an AIDS patient with CMV pseudotumor responding to oral treatment with valganciclovir with complete resolution of the CMV mass. Among reports of non-duodenal pseudotumor reported in the English literature, we found only 14 cases of CMV-induced gastrointestinal pseudotumors in HIV-positive patients. The clinical manifestations, pathologic findings of the CMV pseudotumors, as well as the treatment and outcome of these HIV patients are reviewed.
  
  
  CONCLUSIONS
  CMV pseudotumor should be included in the differential diagnosis of gastrointestinal mass lesions in AIDS patients and in other immunocompromised patients. The tumor often responds to antiviral therapy, but resolution of a CMV mass as a result of oral antiviral therapy has not been previously described. Since pseudotumors secondary to CMV often respond to medical treatment, it is important that the physicians treating severely immunocompromised patients are aware of this entity.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA. Theodoros.Kelesidis@caritaschristi.org
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kelesidis
authors.forename: Shirly
authors.initials: S
authors.lastname: Tozzi
authors.forename: Roger
authors.initials: R
authors.lastname: Mitty
authors.forename: Michael
authors.initials: M
authors.lastname: Worthington
authors.forename: Jorge
authors.initials: J
authors.lastname: Fleisher
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000821:virology*; D000998:Antiviral Agents / Q000627:therapeutic use; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D004378:Duodenal Diseases / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006678:HIV; D015658:HIV Infections / Q000276:immunology / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
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