Acute Necrotizing Pancreatitis in the Setting of CMV Viremia and AIDS: A Case Report and Review of Literature from 1980 to 2012

Stephen Osiro; Raza Muhammad; Jose Ruiz; Anatole Sladen; Njambi Mathenge; Kevin J Tiwari

doi:10.6092/1590-8577/1197

Stephen Osiro Department of Medicine, Woodhull Medical Center. Brooklyn, NY, USA
Raza Muhammad Department of Medicine, Woodhull Medical Center. Brooklyn, NY, USA
Jose Ruiz Department of Pathology, Woodhull Medical Center. Brooklyn, NY, USA
Anatole Sladen Department of Radiology, Woodhull Medical Center. Brooklyn, NY, USA
Njambi Mathenge St. George’s University School of Medicine. Grenada, West Indies
Kevin J Tiwari St. George’s University School of Medicine. Grenada, West Indies

DOI: https://doi.org/10.6092/1590-8577/1197

Keywords: Acquired Immunodeficiency Syndrome, Cytomegalovirus, Ganciclovir, Necrosis, Pancreatitis

Abstract

Context Cytomegalovirus (CMV)-induced pancreatitis in patients with AIDS is a known entity with poor prognosis. Case report We report a case of a 43-year-old woman with AIDS and CMV viremia who was evaluated for hypotension and found to have severe necrotizing pancreatitis. The authors have also conducted a MEDLINE search for CMV-induced pancreatitis from 1980 to 2012 and reviewed the pertinent results. Discussion Until mid-1990s in the United States, pancreatitis due to CMV was mainly diagnosed at autopsy in AIDS patients. However, presumably due to the advent of antiretroviral therapy, there has since been a significant decline in the number of reported cases among these individuals. Rather, our review revealed that the occurrence of CMV-induced pancreatitis has since been described in a variety of clinical settings, ranging from patients on corticosteroid therapy to immunocompetent persons. Conclusions Clinicians need a high index of suspicion to timely diagnose CMV-induced pancreatitis as patients often present with non-specific signs and symptoms. As it occurred in our case, early intervention is crucial and may alter the outcome in such patients.

Image: Immunohistochemistry study showing human herpes virus type 8 (HHV-8).

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