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01-06-2020 | Human Immunodeficiency Virus | Case Report

Disseminated cytomegalovirus infection with bilateral adrenal pseudotumors masquerading as recurrent hematologic malignancy

Authors: Nicolo L. Cabrera, Alexandre E. Malek, Samuel Shelburne, Mahnaz Taremi, Hesham Awadh, Denise Francisco, Alison Robins, Elias Jabbour, Roy F. Chemaly

Published in: Infection | Issue 3/2020

Abstract

Background

Mass-like lesions are an uncommon presentation of cytomegalovirus (CMV) disease.

Case

We report on a case of disseminated CMV disease with bilateral adrenal pseudotumors in a patient with a history of acute leukemia in remission.

Conclusion

In the settings of advanced cancer therapy and organ transplantation, a high index of suspicion for CMV should be maintained for mass-like disease.

Pande A, Dubberke ER. Cytomegalovirus infections of the stem cell transplant recipient and hematologic malignancy patient. Infect Dis Clin North Am. 2019;33:485–500. https://doi.org/10.1016/j.idc.2019.02.008.CrossRefPubMed

Agrawal A, Jain D, Siddique S. Overt lower gastrointestinal bleeding and pseudotumor: a rare presentation of cytomegalovirus infection. Case Rep Med. 2017. https://doi.org/10.1155/2017/9732967.CrossRefPubMedPubMedCentral

Allen TC, Bag R, Zander DS, Cagle PT. Cytomegalovirus infection masquerading as carcinoma in a lung transplant patient. Arch Pathol Lab Med. 2005;129:e1–3. https://doi.org/10.1043/1543-2165(2005)129<e1:CIMACI>2.0.CO;2.CrossRefPubMed

Bhutani MS. Cytomegalovirus-associated colonic pseudotumor. Gastrointest Endosc. 2019;89:641–2. https://doi.org/10.1016/j.gie.2018.11.013.CrossRefPubMed

Boteon YL, Alves IPF, da Silva APC, et al. Obstructive gastric pseudotumor caused by cytomegalovirus in an AIDS patient: a case report and review of surgical treatment. Am J Case Rep. 2015;16:536–41. https://doi.org/10.12659/AJCR.894070.CrossRefPubMedPubMedCentral

de Jesus A, Grossman SA, Paun O. Cytomegalovirus associated colonic pseudotumor: a consequence of iatrogenic immunosuppression in a patient with primary brain tumor receiving radiation and temozolomide. J Neurooncol. 2009;94:445–8. https://doi.org/10.1007/s11060-009-9882-8.CrossRefPubMedPubMedCentral

Farkas ZC, Chawla L, Frager S, Esses E, Yusuf Y, Dworkin B. Spindle cell pseudotumor mimicking malignancy in an immunocompetent patient with a left ventricular assist device. ACG Case Rep J. 2018;5:e43. https://doi.org/10.14309/crj.2018.43.CrossRefPubMedPubMedCentral

Farooq MA, Bhardwaj H, Jones KR. Cytomegalovirus: unusual etiology of lung pseudotumor. Am J Med Sci. 2015;350:237–8. https://doi.org/10.1097/MAJ.0000000000000505.CrossRefPubMed

Grisdale K, Ritterhouse M, Hunter K, Williams MD, Groves MD. Tonsillar pseudotumor: complications of chronically-administered temozolomide. J Neurooncol. 2010;100:475–9. https://doi.org/10.1007/s11060-010-0207-8.CrossRefPubMed

10.

Huang PP, McMeeking AA, Stempien MJ, Zagzag D. Cytomegalovirus disease presenting as a focal brain mass: report of two cases. Neurosurgery. 1997;40:1074–8. https://doi.org/10.1097/00006123-199705000-00037(discussion 1078-9).CrossRefPubMed

11.

Jacob S, Zayyani NR. Cytomegalovirus colitis masquerading as rectal malignancy in an immunocompetent patient. Indian J Patholo Microbiol. 2015;58:80–82. https://doi.org/10.4103/0377-4929.151195.CrossRef

12.

Karakelides H, Aubry M-C, Ryu JH. Cytomegalovirus pneumonia mimicking lung cancer in an immunocompetent host. Mayo Clin Proc. 2003;78:488–90. https://doi.org/10.4065/78.4.488.CrossRefPubMed

13.

Kawasaki S, Osawa S, Sugimoto K, et al. Cecal vanishing tumor associated with cytomegalovirus infection in an immunocompetent elderly adult. World J Gastrointest Oncol. 2010;2:417–20. https://doi.org/10.4251/wjgo.v2.i11.417.CrossRefPubMedPubMedCentral

14.

Kelesidis T, Tozzi S, Mitty R, Worthington M, Fleisher J. Cytomegalovirus pseudotumor of the duodenum in a patient with AIDS: an unrecognized and potentially treatable clinical entity. Int J Infect Dis. 2010;14:e274–e282282. https://doi.org/10.1016/j.ijid.2009.04.015.CrossRefPubMed

15.

Lewis-Jones HG, Ward RG, Garvey C. Cytomegalovirus infection masquerading as colonic neoplasia. Br J Radiol. 1990;63:573–4. https://doi.org/10.1259/0007-1285-63-751-573.CrossRefPubMed

16.

Lima M, Matos AP, Ramalho M. Cytomegalovirus pseudotumor of the colon in an HIV patient. Radiol Case Rep. 2019;14:273–7. https://doi.org/10.1016/j.radcr.2018.11.009.CrossRefPubMed

17.

Lionaki S, Altanis N, Papaxoinis K, Delladetsima I, Daikos G, Boletis JN. A cytomegalovirus-related pseudotumor in the colon of a renal transplant recipient shrunk by antiviral therapy. Transplantation. 2015;99:e46–e4747. https://doi.org/10.1097/TP.0000000000000772.CrossRefPubMed

18.

Mohan H, Bal A, Garg S, Dalal U. Cytomegalovirus-associated pseudotumor simulating gastric malignancy in acquired immunodeficiency syndrome: a case report with review of literature. Jpn J Infect Dis. 2007;60:134–136. https://www.ncbi.nlm.nih.gov/pubmed/17515650. Accessed 3 Feb 2020.

19.

Moulignier A, Mikol J, Gonzalez-Canali G, et al. AIDS-associated cytomegalovirus infection mimicking central nervous system tumors: a diagnostic challenge. Clin Infect Dis. 1996;22:626–31. https://doi.org/10.1093/clinids/22.4.626.CrossRefPubMed

20.

Rajan D, Jacob R, Rashid S, et al. Cytomegalovirus infection presenting as a colonic mass in a patient with acquired immunodeficiency syndrome. Int Med Case Rep J. 2011;4:55–8. https://doi.org/10.2147/IMCRJ.S20407.CrossRefPubMedPubMedCentral

21.

Reggiani Bonetti L, Barresi V, Bertani A, Maccio L, Palmiere C. Human cytomegalovirus induced pseudotumor of upper gastrointestinal tract mucosa: effects of long-term chronic disease? J Med Virol. 2015;87:1041–5. https://doi.org/10.1002/jmv.24152.CrossRefPubMed

22.

Rocha Marussi VH, Pedroso JL, Freitas LF, et al. Teaching NeuroImages: cytomegalovirus infection mimicking a brain tumor in a kidney transplant recipient. Neurology. 2016;87:e281–e282282. https://doi.org/10.1212/WNL.0000000000003406.CrossRefPubMed

23.

Eledrisi MS, Verghese AC. Adrenal insufficiency in HIV infection: a review and recommendations. Am J Med Sci. 2001;321:137–44. https://doi.org/10.1097/00000441-200102000-00005.CrossRefPubMed

24.

Bons J, Moreau L, Lefebvre H. Adrenal disorders in human immunodeficiency virus (HIV) infected patients. Ann Endocrinol. 2013;74:508–14. https://doi.org/10.1016/j.ando.2013.09.002.CrossRef

25.

Ardalan M, Shoja MM. Cytomegalovirus-induced adrenal insufficiency in a renal transplant recipient. Transplant Proceed. 2009;41:2915–6. https://doi.org/10.1016/j.transproceed.2009.07.024.CrossRef

26.

Tejura N, Sonyey A. CMV-associated adrenal insufficiency in a renal transplant recipient. IDCases. 2018;11:44–5. https://doi.org/10.1016/j.idcr.2017.12.009.CrossRefPubMed

27.

Nauclér CS, Geisler J, Vetvik K. The emerging role of human cytomegalovirus infection in human carcinogenesis: a review of current evidence and potential therapeutic implications. Oncotarget. 2019;10:4333–477. https://doi.org/10.18632/oncotarget.27016.CrossRefPubMedPubMedCentral

28.

Lamps LW, Pinson CW, Raiford DS, Shyr Y, Scott MA, Washington MK. The significance of microabscesses in liver transplant biopsies: a clinicopathological study. Hepatology (Baltimore, MD). 1998;28:1532–7. https://doi.org/10.1002/hep.510280613.CrossRef

Title: Disseminated cytomegalovirus infection with bilateral adrenal pseudotumors masquerading as recurrent hematologic malignancy
Authors: Nicolo L. Cabrera
Alexandre E. Malek
Samuel Shelburne
Mahnaz Taremi
Hesham Awadh
Denise Francisco
Alison Robins
Elias Jabbour
Roy F. Chemaly
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Human Immunodeficiency Virus
Polymerase Chain Reaction
Published in: Infection / Issue 3/2020
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-020-01404-9

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Disseminated cytomegalovirus infection with bilateral adrenal pseudotumors masquerading as recurrent hematologic malignancy

Abstract

Background

Case

Conclusion

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Abstract

Background

Case

Conclusion

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