Central Airway Obstruction due to Cytomegalovirus-induced Necrotizing Tracheitis in a Patient with AIDS

Abstract

Cytomegalovirus (CMV) infection in patients with the acquired immunodeficiency syndrome (AIDS) can present as either disseminated disease, pneumonitis, retinitis, gastroenteritis, neuropathy, or a subclinical infection. We report a patient whose initial manifestation of CMV infection was severe central airways obstruction due to necrotizing tracheitis. At bronchoscopy, the lesion appeared deeply ulcerated, distinctly different from previously described airway lesions in patients with AIDS. Mucosal biopsies showed characteristic intranuclear and intracytoplasmic inclusions and cultures yielded only CMV. The patient responded partially to ganciclovir, steroids, and antibiotics against suspected anaerobic superinfection but died as a result of central nervous system disease believed due to toxoplasmosis or lymphoma. CMV infection of the upper airway should be considered in the patient with AIDS presenting with atypical cough or stridor and ulcerated endobronchial lesions.

Endobronchial Lesions in HIV-infected Individuals

“…68 He presented with dyspnea and expectoration of foul-smelling sputum. Stridor was noted on physical examination.…”

Anaesthetic considerations of the HIV-infected patients

“…Airway obstruction from Kaposi's sarcoma or opportunistic infections was described [15][16][17][18][19][20]. Bronchitis, sinusitis and pneumonia can be found at all stages of the disease.…”

A Cytomegalovirus-Associated Mass Presenting With Laryngeal Obstruction

“…5 He had a remote history of prolonged intubation and was stridorous and dyspneic on physical examination. On flexible bronchoscopy, the lesion was described as an "exophytic mass with severe ulcerations .…”

“…Cytomegalovirus pseudotumors in the head and neck have been reported in the brain, 2 submandibular gland, 3 hypopharynx, 4 and trachea. 5 Although there are a few reports 6,7 of CMV infection in the larynx resulting in mucosal ulceration, and a single case 8 of an extranodal, supraglottic lymphoma in the setting of CMV laryngitis, to the best of our knowledge, there has not been a description of a discrete mass in the larynx due to CMV alone. We report the case of an individual who presented with airway obstruction resulting from such a lesion.…”