Complications of systemic cytomegalovirus infection in therapy refracter Hodgkin’s lymphoma

Abstract

Cytomegalovirus infection related changes frequently remain masked by local symptoms of tumor invasion or therapeutic side effects in cancer patients. The spectrum of cytomegalovirus manifestations, however, can be highly varied and may contribute to the failure of different organs with fatal outcome. The case of a 29-year-old female patient is presented who obtained polychemotherapy and allogenic stem cell transplantation following the diagnosis of classical Hodgkin's disease. Despite intensified treatment, only partial response could be achieved and the outcome of the disease was death. Postmortem examination revealed regressive lymph node infiltration as well as nodular liver and spleen manifestations of classical Hodgkin's disease. In addition, parenchymal tissues (lung, kidneys, small intestine, liver, pancreas and ovaries) showed the classical morphology of widespread cytomegalovirus infection. Bilateral enlargement of the ovaries was caused by a partially necrotic giant cell proliferation in the subepithelial cortex. CD30-negativity and cytomegalovirus antigen positivity of the large atypical cell infiltrate supported the diagnosis of cytomegalia oophoritis with morphological overlap between cytomegalovirus-infected giant cells and residual Hodgkin-Reed-Sternberg cells. Further to the cytopathic effect in multiple organs, significant hemophagocytosis was also observed in the spleen, liver and bone marrow. In summary, active cytomegalovirus infection may be a major cause of multi-organ failure in the immunosuppressed oncohematological patient. Careful postmortem analysis demonstrated both the activity of the viral infection and the efficacy of the anti-viral treatment, when applied.

Association of Viral Infections with Risk of Human Lymphomas, Egypt

“…Our results is near to what was found by (Irsai et al, 2012), his study showed similar results of BM infiltration & multiorgan affection in lymphoma patients associated with viral infection especially CMV, he observed cytopathic effect in multiple organs and significant hemophagocytosis was also observed in the spleen, liver and bone marrow. In summary, active cytomegalovirus infection may be a major cause of multi-organ failure in the immunosuppressed patients.…”

Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

“…Analyzing the cases reported in the literature, the median age of the patients was 40 years, and 50% occurred in postmenopausal women. All cases had associated immunosuppression: five cases (27.7%) were related to hematological malignancies 3 , 7 - 9 , 17 ; one (5.5%) was associated with glial neoplas 3 ; five (27.7%) was associated with carcinomas 3 , 10 , 12 , 15 , 16 ; one (5.5%) was associated with lupus glomerulonephritis 6 ; and six (33.6%; including the present report) were associated with AIDS. 2 , 4 , 11 , 13 , 14 In one case, CMV ovarian infection affected a fibrothecoma, which was present in one of the ovaries of a patient with refractory angioimmunoblastic non-Hodgkin lymphoma.…”

Cytomegalovirus Oophoritis Mimicking Burkitt's Lymphoma Recurrence: A Case Report and Literature Review

“…Several studies have reported rapid clinical improvement of severe CMV infections in immunocompromised patients following antiviral therapy; however, the criteria for the use of specific antiviral drugs are not well established (6). There have been only 19 cases of CMV oophoritis reported, of which 3 were diagnosed by surgical resection, and the rest were diagnosed on autopsy (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). There have been no previous reports of treatment of CMV oophoritis with antiviral drugs.…”