Haemorrhagic cystitis due to cytomegalovirus in a patient with AIDS

Abstract

Background: Cytomegalovirus-related infections are commonly seen in immunocompromised patients. However, haemorrhagic cystitis is an exceptionally rare associated manifestation. We present an unusual case of cytomegalovirus-related haemorrhagic cystitis in a patient with acquired immune deficiency syndrome (AIDS). Case presentation: A 33-year-old HIV-positive female presented with acute gross haematuria and suprapubic pain. Cystoscopy revealed features suggestive of haemorrhagic cystitis with clots in the bladder and an ulcerative lesion on the left lateral wall which was biopsied. Histology demonstrated the presence of enlarged cells containing eosinophilic intranuclear and ill-defined amphophilic intracytoplasmic inclusions. Immunohistochemistry was positive for cytomegalovirus. Conclusion: This case appears to be the first of its kind reported in South Africa highlighting the importance of considering cytomegalovirus as a potential infectious aetiology in AIDS patients with haematuria. Bladder irrigation with normal saline with or without clot evacuation combined with Ganciclovir are associated with good outcome.

Cytomegalovirus haemorrhagic cystitis in a pregnant patient with AIDS

“…Abnormal cystoscopic findings include hyperaemic, oedematous or inflamed urothelium, haemorrhagic inflammation or ulcerative bladder mucosal lesions. 7 – 9 However, these findings are non-specific, and endoscopists should have a low threshold to biopsy abnormal-looking areas, especially in a severely immunocompromised patient. Some authors have suggested that deeper biopsies, which include the muscularis layer, might be necessary to confirm the diagnosis as CMV might only be detected in the muscle layer in certain cases.…”

“…The cardinal features of CMV infection include nuclear enlargement and cytomegaly of the infected cells. 8 Prominent large intranuclear and intracytoplasmic inclusions with a basophilic to amphophilic appearance are one of the pathognomonic findings.…”

“…11 The diagnostic value of CMV on histology is significant as other modalities such as serology or PCR analysis and detection in urine samples have limited specificity and cannot be used as a diagnostic tool in isolation. 8,12 Histopathological features are characteristic and morphological findings can already suggest the diagnosis with confirmation via immunohistochemistry for CMV. The cardinal features of CMV infection include nuclear enlargement and cytomegaly of the infected cells.…”