Faldetta Kimberly F, Kattakuzhy Sarah, Wang Hao-Wei, Sereti Irini, Sheikh Virginia
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
BMC Infect Dis. 2014 Jun 9;14:313. doi: 10.1186/1471-2334-14-313.
Appendicitis occurs with increased frequency in HIV infected compared to HIV uninfected persons. CMV-related appendicitis specifically presents with typical appendicitis symptoms including surgical abdomen, fever and leukocytosis and may have a more severe course with higher mortality than other types of infective appendicitis. We report the first case of CMV appendicitis as a manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS).
The patient was a 38 year old woman with a recent diagnosis of HIV infection who complained of right lower quadrant pain, anorexia, nausea and fevers two weeks after initiating antiretroviral therapy. Acute appendicitis was suspected and the patient underwent an appendectomy. Pathologic examination of the resected appendiceal tissue demonstrated inflammation with perforation and cytopathic changes typical of CMV that were positive for CMV by immunostain. This presentation of CMV abruptly after antiretroviral therapy initiation with a pronounced cellular infiltration of the tissue, is consistent with CMV-IRIS presenting as appendicitis.
Appendicitis can be a rare manifestation of CMV-IRIS in HIV-infected patients who start antiretroviral therapy. Evaluation of appendiceal tissue for cytopathic changes and CMV should be considered in acute appendicitis in HIV infected persons.
与未感染艾滋病毒的人相比，阑尾炎在艾滋病毒感染者中更为常见。巨细胞病毒（CMV）相关性阑尾炎具体表现为典型的阑尾炎症状，包括急腹症、发热和白细胞增多，并且与其他类型的感染性阑尾炎相比，其病程可能更严重，死亡率更高。我们报告首例以免疫重建炎症综合征（IRIS）表现的CMV阑尾炎病例。
患者为一名38岁女性，近期诊断为艾滋病毒感染，在开始抗逆转录病毒治疗两周后出现右下腹疼痛、厌食、恶心和发热。怀疑为急性阑尾炎，患者接受了阑尾切除术。切除的阑尾组织病理检查显示炎症伴穿孔以及CMV典型的细胞病变改变，免疫染色CMV呈阳性。在开始抗逆转录病毒治疗后突然出现这种CMV表现，且组织有明显的细胞浸润，符合以阑尾炎形式表现的CMV-IRIS。
阑尾炎可能是开始抗逆转录病毒治疗的艾滋病毒感染患者中CMV-IRIS的罕见表现。对于艾滋病毒感染者的急性阑尾炎，应考虑评估阑尾组织的细胞病变改变和CMV情况。
