Cerebral mass lesion due to cytomegalovirus in a patient with AIDS: case report and literature review

Abstract

Cytomegalovirus (CMV) disease in acquired immunodeficiency syndrome (AIDS) patients most commonly presents as chorioretinitis and gastro-intestinal infection. Neurological involvement due to CMV may cause several clinical presentations: polyradiculitis, myelitis, encephalitis, ventriculo-encephalitis, and mononeuritis multiplex. Rarely, cerebral mass lesion is described. We report a 39 year-old woman with AIDS and previous cerebral toxoplasmosis. She presented with fever, seizures, and vulval ulcers. Her chest X-ray showed multiple lung nodules, and a large frontal lobe lesion was seen in a brain computed tomography scan. She underwent a brain biopsy through a frontal craniotomy, but her condition deteriorated and she died in the first postoperative day. Histopathological studies and immunohistochemistry disclosed CMV disease, and there was no evidence of cerebral toxoplasmosis, bacterial, mycobacterial or fungal infection. CMV disease should be considered in the differential diagnosis of cerebral mass lesion in AIDS patients. High suspicion index, timely diagnostic procedures (surgical or minimally invasive), and proper utilization of prophylactic and therapeutic medication could improve outcome of these patients.

Nocardia amikacinitolerans and cytomegalovirus: distinctive clinical and radiological characterization of the rare etiologies of brain abscesses: report of 2 cases

“…Moreover, there are only 8 previously documented cases of intracranial CMV masses, all of which occurred in patients with significantly low CD4-positive T-lymphocyte counts (8-81 cells/ml). 4,14,23,37,48 As shown in Table 2, 48 all these patients had AIDS, were significantly symptomatic, and died soon after diagnosis. Characteristics of lesions on MRI were also similar to those of our patient's: focal, most often single, supratentorial ring-enhancing lesions that could not be distinguished as either neoplasm or infection.…”