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Review
. 2021 Mar 10;21(1):252.
doi: 10.1186/s12879-021-05943-w.

Refractory pharyngeal ulceration due to cytomegalovirus in a patient with HIV infection: a case report and literature review

Morichika Osa  1   2 , Akihiro Sato  1 , Maki Sakagami  1 , Masaki Machida  1 , Takao Sato  1 , Ayaka Tsukimori  1 , Shinji Fukushima  1 , Itaru Nakamura  3 , Ryo Akai  4 , Kiyoaki Tsukahara  4 , Hidehiro Watanabe  1
Affiliations
Review

Refractory pharyngeal ulceration due to cytomegalovirus in a patient with HIV infection: a case report and literature review

Morichika Osa et al. BMC Infect Dis. .

Abstract

Background: Cytomegalovirus (CMV) is an important pathogen among immunocompromised hosts. Typically, CMV in human immunodeficiency virus (HIV) infection causes diseases of the retina, digestive tract, lungs and liver, but there are few cases of CMV infection of the pharynx and larynx.

Case presentation: A 57-year-old man with HIV infection was admitted because of pharyngeal pain. Before and after admission, pharyngeal biopsies guided by laryngeal endoscopy were performed four times, but pathological examination showed nonspecific inflammation, and the cause of pharyngeal ulceration was unclear. Additionally, the ulceration deteriorated after initiation of retroviral therapy. Laryngomicrosurgery was conducted under general anesthesia to remove tissue, and pathological diagnosis confirmed CMV infection. Pathological features included enlargement of the cytoplasm and nucleus in infected cells, and intranuclear bodies called owl's eye inclusions. Ganciclovir dramatically improved the symptoms and laryngoscopic findings.

Conclusions: This case was diagnosed as pharyngitis and pharyngeal ulceration caused by CMV infection, related to immune reconstitution inflammatory syndrome. In previous reports of CMV-induced pharyngeal or laryngeal ulceration in HIV infection, we found six cases similar to our present case. All cases were diagnosed by biopsy. The present case indicates the importance of biopsy for definitive diagnosis. CMV infection should be considered as a differential diagnosis of pharyngeal ulceration in patients with HIV infection.

Keywords: Case report; Cytomegalovirus; Ganciclovir; HIV; Pharyngeal ulceration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a: Axial section of head and neck computed tomography. b: Coronal section of head and neck computed tomography. Both images show the right arytenoid edema (yellow circle)
Fig. 2
Fig. 2
a: Initial laryngoscopy findings: right arytenoid edema (yellow circle) and pharyngeal ulceration (blue circle). b: Laryngoscopy at admission: right arytenoid edema had deteriorated
Fig. 3
Fig. 3
a: Hematoxylin–eosin: histopathological features of lesion demonstrating enlargement of the cell nucleus (white circle). b: Positive immunostaining for CMV by monoclonal antibody (black circle)
See this image and copyright information in PMC

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