Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease

Abstract

A case of isolated necrotizing cytomegalovirus (CMV) oophoritis disclosed only by necropsy studies in a patient with AIDS, is described. This unusual case report is discussed with a review of the literature dealing with CMV involvement of genital organs in the immunocompromised host, and in patients with HIV infection and AIDS.

Bilateral cytomegalovirus (CMV) oophoritis mimicking widely metastatic carcinoma: a case report and review of the literature

“…Originally described by Subietas et al in 1977 [ 8 ], bilateral CMV oophoritis is a rare pathologic finding that is usually associated with a systemic infection. An underlying malignancy or immunosuppressive status is almost always present and steroid therapy has been shown to be a strong risk factor for CMV reactivation in both groups [ 5 , 8 , 11 ], as it is in our current case. It has been suggested that previously reported isolated CMV oophoritis might represent sampling error [ 7 ].…”

“…In fact, the lack of microthrombi was noted by Subietas et al [ 8 ] and actually considered one of the arguments against a virally induced vasculopathy. However, our case provides evidence for an alternate pathway for perpetuation of CMV infection in the ovary that does not require post menopausal restrictive vascular changes, thus providing one possible explanation for the nearly equal distribution between pre- and post- menopausal patients [ 1 - 3 , 5 , 9 , 10 ].…”

“…It is worth noting that only slightly over half of the reported CMV oophoritis cases were from post-menopausal women [ 1 - 3 , 5 , 9 , 10 ], even though it was historically thought to be a disease of post-menopausal patients [ 4 , 6 - 8 ]. This revised age distribution has some implications with regards to pathogenesis.…”

“…It is unclear whether ovarian CMV infection is a manifestation of systemic infection or actually the primary site of involvement. The putative vascular/restrictive pathogenesis model described above along with cases of isolated CMV oophoritis [ 5 , 7 ] make the ovaries plausible candidates to serve as CMV reservoirs. Additionally, CMV DNA has been identified in arterial wall smooth muscle cells in both seropositive and seronegative healthy individuals [ 17 ].…”

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

“…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. 7 Fourteen of the 18 cases (77.7%) presented pre-mortem and post-mortem documentation of systemic involvement by CMV; 50% had an association with other opportunistic disease; and three cases (16.6%) received the treatment with ganciclovir.…”