Cytomegalovirus-associated appendicitis in a patient with the acquired immunodeficiency syndrome

Lin, Janet; Bleiweiss, Ira J.; Mendelson, Meryl H.; Szabo, Susan; Schwartz, Ira

doi:10.1016/0002-9343(90)90353-f

Cited by 22 publications

(10 citation statements)

References 13 publications

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“…At the same time, there was no concerted effort to explain why purulent appendicitis would occur when no fecalith was present. However, upon review of the literature, lymphoid hyperplasia secondary to viral infection repeatedly surfaced [1][2][3][4][5][6][7][8][9][10], and it was for this reason that we undertook our sample study. We now wish to present the imaging and pathologic findings in these patients and suggest a pathophysiologic mechanism for the occurrence of non-fecalithinduced appendicitis.…”

Section: Introductionmentioning

confidence: 99%

Non-fecalith-induced appendicitis: etiology, imaging, and pathology

et al. 2015

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This study aims to document the imaging and pathology findings in non-fecalith-induced appendicitis. We reviewed the imaging and pathologic findings in 40 patients with histologically proven purulent appendicitis seen over a 2-year period. Findings documented were (1) total appendiceal involvement, (2) predominant appendiceal tip involvement, (3) presence of a fecalith, and (4) presence of lymphoid hyperplasia. There were a total of 40 patients, 28 males and 12 females. The age range was 2-18 years with a mean of 11.5 years. Twenty-two (55 %) patients demonstrated classic purulent appendicitis of the whole appendix, 20 (91 %) of these appendices had a fecalith. Eighteen (45 %) patients demonstrated purulent appendicitis confined to or predominately involving the tip of the appendix, and all 18 (100 %) patients demonstrated marked lymphoid hyperplasia. Only two (11 %) of these appendices had a fecalith. Overall, a fecalith was found in only 55 % of our cases, while 45 % demonstrated no fecalith, but rather marked lymphoid hyperplasia. Lymphoid hyperplasia appeared to be the underlying predisposing cause of purulent appendicitis in these cases.

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Section: Introductionmentioning

confidence: 99%

Non-fecalith-induced appendicitis: etiology, imaging, and pathology

et al. 2015

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“…Appendicitis was first reported in association with HIV in 1986 [1]; early reports focused on opportunistic causes of appendicitis including Kaposi's sarcoma [1][2][3][4] and cyto-megalovirus [5][6][7][8][9][10][11]. Subsequently, other opportunistic agents were described to either cause or mimic acute appendicitis among HIV-infected patients, including Mycobacterium spp.…”

Section: Introductionmentioning

confidence: 99%

Appendicitis in HIV‐infected patients during the era of highly active antiretroviral therapy

2008

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Background Limited studies have suggested increased incidence rates and unusual clinical presentations of appendicitis among HIV‐infected patients during the pre‐highly active antiretroviral therapy (HAART) era. Data in the HAART era are sparse, and no study has evaluated potential HIV‐related risk factors for the development of appendicitis. Methods We retrospectively studied 449 HIV‐infected patients receiving care at a US Naval hospital involving 4750 person‐years (PY) of follow‐up. We also evaluated the rates of appendicitis among HIV‐negative persons at our medical facility. We compared demographics, HIV‐specific data, and HAART use in HIV‐infected patients with and without appendicitis. Results Sixteen (3.6%) of 449 patients developed appendicitis after HIV seroconversion. The incidence rate was 337 cases/100 000 PY, more than fourfold higher than among HIV‐negative persons. Eighty‐eight per cent of cases among HIV‐infected patients had an elevated white blood count at presentation, 39% were complicated, and 64% required hospitalization. HIV‐infected patients with appendicitis compared with those who did not develop appendicitis were less likely to be receiving HAART (25 vs. 71%, P<0.001), had higher viral loads (3.5 vs. 1.7 log10 HIV‐1 RNA copies/mL, P=0.005), and were younger (median age of 30 vs. 41 years, P<0.002). In the multivariate model, receipt of HAART remained protective [odds ratio (OR) 0.21, P=0.012] for appendicitis, while younger age was positively associated (OR 1.08, P=0.048) with appendicitis. Conclusion Acute appendicitis occurs at higher incidence rates among HIV‐infected patients compared with the general population. Our study demonstrates that the lack of HAART may be a risk factor for appendicitis among HIV‐infected patients; further studies are needed.

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“…[7][8][9][10][11][12][13] In terms of viruses, the literature is generally restricted to case studies, implicating viruses such as measles, adenovirus or cytomegalovirus in immunocompromised patients. [14][15][16][17][18][19][20][21] Herpes viruses are ubiquitous pathogens in children, remaining quiescent after an active infection. Their high prevalence in childhood prompted us to investigate their possible role in the pathogenesis of acute appendicitis, based on the hypothesis that the herpes viruses are latent in the appendix, and are periodically reactivated by certain triggers such as individual immune status, stress or sunlight.…”

Section: Discussionmentioning

confidence: 99%

“…1,6 Additionally, bacterial infections such as Bacteroides fragilis, Escherichia coli, Yersinia, Salmonella or Shigella, parasitic infestations such as Entamoeba histolytica, or enteric and systemic viral diseases such as measles virus, adenovirus and cytomegalovirus (CMV) infection, can cause a reaction of the lymphoid follicle. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] White blood cell count and C-reactive protein concentrations in serum play only a supportive role in the diagnosis of acute appendicitis in children. 22,23 Among other laboratory methods for the detection of acute appendicitis, new inflammatory markers such as interleukin (IL)-6, lipopolysaccharide-binding protein (LBP) and nuclear factor (NF)-kappaB have been studied.…”

Section: Introductionmentioning

confidence: 99%

Detection of herpes viruses in children with acute appendicitis

Katzoli

Sakellaris

Ergazaki

et al. 2009

Journal of Clinical Virology

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AbstractsOf all the specimens, the omentum was the most commonly infected tissue (63.0%) while the appendix and peripheral blood specimens were found to be positive for viral infection in 60.5% and 50% of cases, respectively. The CMV IgG+ antibodies were positive in 54% of the control cases while 86% of the same group presented HHV-6 IgG+ antibodies. Conclusion To the best of our knowledge, this is the first study documenting the presence of herpes virus DNA in children with acute appendicitis, suggesting that possible viral infection or reactivation is associated with childhood appendicitis.

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Cytomegalovirus-associated appendicitis in a patient with the acquired immunodeficiency syndrome

Cited by 22 publications

References 13 publications

Non-fecalith-induced appendicitis: etiology, imaging, and pathology

Non-fecalith-induced appendicitis: etiology, imaging, and pathology

Appendicitis in HIV‐infected patients during the era of highly active antiretroviral therapy

Detection of herpes viruses in children with acute appendicitis

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