Cytomegalovirus-Associated Severe Fatal Necrotizing Pancreatitis in a Patient with Interstitial Pneumonitis Treated with Steroids. An Autopsy Case
Abstract
Context An autopsy case of cytomegalovirus (CMV) associated with fatal severe pancreatitis is reported. Case report A 76-year-old man presented with high fever and was admitted to our hospital for evaluation. Imaging modalities, including chest X-ray, CT and MRI, revealed interstitial pneumonia. Blood laboratory tests showed positive anti-nuclear antigen (x80), but collagen diseases were not identified. The patient was treated with steroids (prednisolone 30 mg/day). Two months later, the patient developed acute abdominal pain. Serum laboratory tests revealed an elevated amylase level (1,296 IU/L), and CT demonstrated acute pancreatitis. The patient died of multiple organ failure from the acute pancreatitis three days after the onset of the acute pancreatitis. An autopsy revealed severe necrotizing acute pancreatitis. Numerous large inclusions of CMV were found in the acinar and ductal cells of the pancreas. Numerous CMV inclusions were also seen in the degenerated and necrotic pancreatic acinar cells. CMV-infected cells were immunohistochemically positive for CMV antigen, CMV early antigen and CMV late antigen, indicating active replication and regression of CMV. Conclusion The findings strongly suggest that severe CMV infection can occur after steroid administration, and that CMV infection can be the cause of severe fatal acute necrotizing pancreatitis.
Image: The lungs show intestinal pneumonitis.
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References
Iwasaki T, Tashiro A, Satodate R, Sata T, Kurata T. Acute pancreatitis with cytomegalovirus infection. Acta Pathol Jpn 1987; 37:1661-8. [PMID 2829502]
Bigio EH, Haque AK. Disseminated cytomegalovirus infection presenting with acalculous cholecystitis and acute pancreatitis. Arch Pathol Lab Med 1989; 113:1287-9. [PMID 2554845]
Kaşifoğlu T, Korkmaz C, Ozkan R. Cytomegalovirus-induced interstitial pneumonia in a patient with dermatomyositis. Clin Rheumatol 2006; 25:731-3. [PMID 16267608]
Tiple A, Kamar N, Esposito L, Mengelle C, Combelles S, Otal P, et al. Unusual presentation of cytomegalovirus infection in patients after organ transplant. Exp Clin Transplant 2009; 7:45-9. [PMID 19364312]
Wilcox CM, Forsmark CE, Grendell JH, Darragh TM, Cello JP. Cytomegalovirus-associated acute pancreatic disease in patients with acquired immunodeficiency syndrome: report of two patients. Gastroenterology 1990; 99:263-7. [PMID 2160899]
Tomonari A, Takahashi S, Takasugi K, Ooi J, Tsukada N, Konuma T, et al. Pancreatic hyperamylasemia and hyperlipasemia in association with cytomegalovirus infection following unrelated cord blood transplantation for acute myelogenous leukemia. Int J Hematol 2006; 84:438-44. [PMID 17189226]
Yasumoto N, Hara M, Kitamoto Y, Nakayama M, Sato T. Cytomegalovirus infection associated with acute pancreatitis, rhabdomyolysis and renal failure. Int Med 1992; 31:426-30. [PMID 1319248]
Shimada A, Koga T, Shimada M, Kitajima T, Mitsui T, Sata M, Aizawa H. Cytomegalovirus pneumonitis presenting small nodular opacities. Intern Med 2004; 43:1198-120. [PMID 15645659]
Oku T, Maeda M, Waga E, Wada Y, Nagamachi Y, Fujita M, et al. Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient. J Gastroenterol 2005; 40:987-92. [PMID 16261436]
Ikura Y, Matsuo T, Ogami M, Yamazaki S, Okamura M, Yoshikawa J, Ueda M. Cytomegalovirus associated pancreatitis in a patient with systemic lupus erythematosus. J Rheumatol 2000; 27:2715-7. [PMID 11093460]
Parenti DM, Steinberg W, Kang P. Infectious causes of acute pancreatitis. Pancreas 1996; 13:356-71. [PMID 8899796]
Terada T, Kawaguchi M, Furukawa K, Sekido Y, Osamura Y. Minute mixed ductal-endocrine carcinoma of the pancreas with predominant intraductal growth. Pathol Int 2002; 52:740-6. [PMID 12685552]
Andrade ZR, Garippo AL, Saldiva PH, Capelozzi VL. Immunohistochemical and in situ detection of cytomegalovirus in lung autopsies of children immunocompromised by secondary interstitial pneumonia. Pathol Res Pract 2004; 200:25-32. [PMID 15157047]
Riddell SR. Pathogenesis of cytomegalovirus pneumonia in immunocompromised hosts. Semin Respir Infect 1995; 10:199-208. [PMID 8668847]
Terada T, Kawaguchi M. Primary clear cell adenocarcinoma of the peritoneum. Tohoku J Exp Med 2005; 206:271-5. [PMID 15942157]
Margreiter R, Schmid T, Dunser M, Tauscher T, Hengster P, Konigsrainer A. Cytomegalovirus (CMV) -pancreatitis: a rare complication after pancreas transplantation. Transplant Proc 1991; 23:1619-22. [PMID 1846480]
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