Cytomegalovirus pseudotumor of the duodenum in a patient with AIDS: an unrecognized and potentially treatable clinical entity.
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.
Kelesidis
Theodoros
T
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
Tozzi
Shirly
S
Mitty
Roger
R
Worthington
Michael
M
Fleisher
Jorge
J
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
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
Arch Pathol Lab Med. 1989 May;113(5):461-4
2540725
Transplantation. 1998 Dec 15;66(11):1562-5
9869101
Am J Gastroenterol. 1986 Aug;81(8):714-7
3017098
Am J Gastroenterol. 1992 Jun;87(6):771-4
1317095
AJR Am J Roentgenol. 1991 Jun;156(6):1302-4
1851380
Ann Intern Med. 1990 Oct 15;113(8):589-93
2169217
J Infect Dis. 1988 Aug;158(2):449-56
2841381
Br J Radiol. 1990 Jul;63(751):573-4
2167743
Dig Dis Sci. 2000 Sep;45(9):1781-5
11052320
Vet Pathol. 2004 Nov;41(6):691-5
15557079
Clin Infect Dis. 1992 Oct;15(4):609-14
1330013
Am J Gastroenterol. 1993 Nov;88(11):1882-6
8237936
Am J Gastroenterol. 1993 Jul;88(7):1108-11
8391211
J Clin Gastroenterol. 1992 Jun;14(4):293-7
1318892
Endoscopy. 2007 Feb;39 Suppl 1:E23
17285502
Am J Med. 1989 May;86(5):539-46
2712061
J Heart Lung Transplant. 1997 Nov;16(11):1171-5
9402518
Clin Infect Dis. 2003 Sep 1;37(5):e68-71
12942421
Postgrad Med J. 1996 Jul;72(849):429-30
8935605
Ann Intern Med. 1988 Apr;108(4):585-94
2831765
Dig Dis Sci. 1989 Apr;34(4):623-9
2539285
Thorax. 1989 Apr;44(4):241-6
2548297
Arch Intern Med. 1987 Apr;147(4):787-8
3030215
J Pediatr Surg. 1990 Jun;25(6):696-8
2162941
AJR Am J Roentgenol. 1999 Apr;172(4):939-40
10587124
J Clin Gastroenterol. 1996 Jan;22(1):41-4
8776095
Gastroenterology. 1984 Dec;87(6):1407
6092200
Jpn J Infect Dis. 2007 May;60(2-3):134-6
17515650
Radiology. 1987 May;163(2):317-23
3031723
Pediatr Infect Dis. 1985 Sep-Oct;4(5):550-2
2995936
Am J Gastroenterol. 1986 Oct;81(10):944-50
3020973
Am J Gastroenterol. 1989 Jul;84(7):794-7
2545094
J Dermatol Sci. 2000 Apr;22(3):196-204
10698156
Am J Gastroenterol. 1996 Jan;91(1):168-9
8561127
J Clin Pathol. 1989 Oct;42(10):1055-64
2555397
Singapore Med J. 1997 Jan;38(1):32-4
9269353
Ann Intern Med. 1993 Nov 1;119(9):924-35
8215005