title: Circulating cytomegalic cells in a patient with advanced HIV presenting with cytomegalovirus rhinosinusitis.
abstract: We report a patient with newly diagnosed late-stage HIV presenting with fever, rhinosinusitis and cognitive impairment. Analysis of cerebrospinal fluid and nasal turbinate tissue confirmed cytomegalovirus (CMV) infection. CMV pp65 antigen assay conducted on peripheral blood leukocytes revealed large CMV infected mononuclear cells (diameter ∼ 50 μm) with an unusual cytoplasmic pattern of pp65 staining. These large cells were also seen in buffy coat Wright's stained smears; their size, morphology and pp65 antigen uptake pattern were consistent with CMV infected cytomegalic endothelial cells. While CMV sinus infections are occasionally encountered in AIDS patients, this is the first report to document CMV infection of the nasal mucosa with secondary sinusitis and chronic suppurative otitis media. Furthermore, the detection of circulating cytomegalic cells is described--a rare finding with pathological and clinical significance in immunocompromised patients with CMV disease.
authors.affiliation: Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Sridhar
authors.affiliation: Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Iris W S
authors.initials: IW
authors.lastname: Li
authors.affiliation: Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China.
authors.forename: Sally C Y
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Department of Microbiology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China; Research Centre of Infection and Immunology, The University of Hong Kong, University Pathology Building, Queen Mary Hospital, Hong Kong SAR, China. Electronic address: kyyuen@hkucc.hku.hk.
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000175:diagnosis*; D001921:Brain / Q000000981:diagnostic imaging; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D042783:Endothelial Cells / Q000821:virology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007963:Leukocytes, Mononuclear / Q000473:pathology* / Q000821:virology*; D008875:Middle Aged; D009297:Nasal Mucosa / Q000000981:diagnostic imaging / Q000648:ultrastructure / Q000821:virology*; D010750:Phosphoproteins / Q000032:analysis; D011859:Radiography; D060888:Real-Time Polymerase Chain Reaction; D012220:Rhinitis / Q000821:virology; D012852:Sinusitis / Q000821:virology; D014763:Viral Matrix Proteins / Q000032:analysis
chemical_list: D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa
keywords: Cytomegalic endothelial cell; Cytomegalovirus; Rhinosinusitis