PMID- 23984594
OWN - NLM
STAT- MEDLINE
DCOM- 20131017
LR  - 20190823
IS  - 0387-5911 (Print)
IS  - 0387-5911 (Linking)
VI  - 87
IP  - 4
DP  - 2013 Jul
TI  - [CMV-induced duodenal papillitis in a patient with HIV-1 infection].
PG  - 441-5
AB  - We present herein a case report of a 59-year-old patient with HIV-1 infection who 
      developed a CMV-induced pseudotumor of the duodenum. The patient presented with 
      oral pain and dysphagia. Physical examination revealed oral thrush. An EIA and a 
      Western blot assay for antibodies to HIV were positive. His CD4-positive 
      lymphocyte count was initially 49/microL with an HIV viral load of 2.6 x 10(5) 
      copies/mL. Cytomegalovirus (CMV) reactivation was detected with the CMV 
      antigenemia assay. He had CMV retinitis in both eyes with unilateral blurring. An 
      endoscopic study revealed candida esophagitis, and a tumor-like lesion with an 
      irregular ulcer at the papilla of Vater. Histological and immunohistochemical 
      studies revealed a CMV-induced pseudotumor and severely inflamed duodenal mucosa 
      with infiltration of CMV-positive cells. The patient was treated with oral 
      valganciclovir and fluconazole for three weeks. As the oral thrush and retinitis 
      showed improvement, he began antiretroviral therapy (ART), consisting of 
      raltegravir and TDF/ FTC. One month later the patient's CD4-positive cells 
      increased to 130/microL and the level of HIV-RNA decreased to 160 copies/mL, The 
      CMV retinitis had transiently worsened because of an ART-induced inflammatory 
      response, immune reconstitution inflammatory syndrome (IRIS). Six months after 
      the ART initiation, an endoscopic study revealed that the esophagitis and the 
      lesion at the papilla had improved. Biopsy showed no CMV-positive cells in the 
      epithelium. The patient was now in a relatively healthy condition. CMV-induced 
      pseudotumors of the duodenum are rare, and sometimes resemble malignancy. 
      However, because this tomor responds to medical treatment physicians treating 
      severely immunocompromised patients should be aware of its presentation and 
      treatment.
FAU - Minami, Rumi
AU  - Minami R
AD  - Internal Medicine, Clinical Research Institute, National Hospital Organization, 
      Kyushu Medical Center.
FAU - Takahama, Soichiro
AU  - Takahama S
FAU - Nakashima, Eriko
AU  - Nakashima E
FAU - Yamamoto, Masahiro
AU  - Yamamoto M
LA  - jpn
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
PL  - Japan
TA  - Kansenshogaku Zasshi
JT  - Kansenshogaku zasshi. The Journal of the Japanese Association for Infectious 
      Diseases
JID - 0236671
SB  - IM
MH  - AIDS-Related Opportunistic Infections/*pathology
MH  - *Ampulla of Vater
MH  - Cholangitis/*pathology
MH  - Cytomegalovirus Infections/*pathology
MH  - HIV Infections/*complications
MH  - *HIV-1
MH  - Humans
MH  - Male
MH  - Middle Aged
EDAT- 2013/08/30 06:00
MHDA- 2013/10/18 06:00
CRDT- 2013/08/30 06:00
PHST- 2013/08/30 06:00 [entrez]
PHST- 2013/08/30 06:00 [pubmed]
PHST- 2013/10/18 06:00 [medline]
AID - 10.11150/kansenshogakuzasshi.87.441 [doi]
PST - ppublish
SO  - Kansenshogaku Zasshi. 2013 Jul;87(4):441-5. doi: 
      10.11150/kansenshogakuzasshi.87.441.