Journal of Diagnostics Concepts & Practice ›› 2025, Vol. 24 ›› Issue (03): 320-327.doi: 10.16150/j.1671-2870.2025.03.011
• Original article • Previous Articles Next Articles
ZENG Dong, SONG Shu, YANG Yuexiang, XU Jingjing, GUO Wenjuan, ZHENG Ye, SHI Yuhan, FENG Yanling()
Received:
2024-10-22
Accepted:
2025-05-08
Online:
2025-06-25
Published:
2025-06-25
Contact:
FENG Yanling
E-mail:fyl-hy@163.com
CLC Number:
ZENG Dong, SONG Shu, YANG Yuexiang, XU Jingjing, GUO Wenjuan, ZHENG Ye, SHI Yuhan, FENG Yanling. Clinicopathological features and differential diagnosis of AIDS with CMV infection[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 320-327.
Table 1
Clinical data of patients with HIV combined with CMV infection
CMV infection case | Number | Age range | Sex | Clinical manifestation and gastrointestinal endoscopy | CD4+ T cell(number/μL) | Effect & prognosis |
---|---|---|---|---|---|---|
Stomach | 10 | 27-65 | Male 9,Female 1 | nausea, poor appetite, stomach pain and discomfort mainly, hemateesis in 1 case, fever in 4 cases, gastroscopic congestion and erosion mainly, ulcer in 3 cases, bleeding in 1 case | 9-80 | 5 cases improved, 3 cases showed no obvious therap-eutic effect, 2 cases were lost to follow-up. |
Esophagus | 5 | 31-55 | Male 4, Female 1 | dysphagia with pain in 3 cases, fever in 3 cases, poor appetite with vomiting in 1 case. gastroscopic congestion and edema with erosion, ulcer in 1 case. | 5-34 | 1 cases improved, 3 cases showed no obvious therap-eutic effect, 1 case with death |
Intestine | 7 | 17-63 | Male 6, female 1 | abdominal pain and diarrhea mainly, hematochezia 1 case, fever 4 cases, nausea and vomiting 2 cases. enteroscopic ulcer 1 case, bleeding 1 case, the rest congested and erosion | 47-362 | 2 cases improved,4 cases showed no obvious therap-eutic effect,1 cases were lost to follow-up |
More than two parts of the digestive tract | 10 | 24-57 | Male 10 | nausea and vomiting, loss of appetite, stomach pain, abdominal pain and diarrhea and other combined symptoms predominate, hematochezia 1 case, fever 6 cases. gastroenteroscopic erosion and congestion, ulcer 3 cases, bleeding 1 case | 12-130 | 2 cases improved, 2 cases showed no obvious therap-eutic effect, 2 case with death,4 cases were lost to follow-up |
Lung | 1 | 29 | Male | cough, hemoptysis, fever | 6 | death |
Skin | 1 | 52 | Male | abscess, localized pain | 188 | improved |
Perianal | 1 | 35 | Male | purulent secretion, skin lesions | 44 | improved |
Lymph node | 2 | 18-33 | Male 2 | enlarged lymph nodes | 79-125 | 2 cases improved |
Submandibular gland | 1 | 30 | Male | localized swelling and pain | 14 | improved |
Figure 1
Pathomorphologic and immunohistochemical features of CMV infection in the gastric mucosa and ileocecal part A: Giant eosinophilic inclusion bodies with perinuclear halos (green arrows) were seen in multiple intestinal mucosal epithelial nuclei in the ileocecal region. (HE, ×400); B: Intestinal mucosal intraepithelial inclusion bodies with strong positive CMV protein expression.(IHC, ×400); C: Gastric mucosal ulcer formation, massive acute and chronic inflammatory cell infiltration in the interstitium, enlarged mucosal epithelial cytosol, slightly basophilic cytoplasm, and eosinophilic intranuclear inclusion bodies (green arrows). (HE, ×400); D: Inflammatory necrotic area of gastric mucosal epithelium with positive expression of CMV protein. (IHC, ×400).
Figure 2
Pathomorphologic, immunohistochemical and special staining features of CMV combined with aspergillus infection in lung puncture tissue A: Lung puncture tissue (HE, ×40); B: Localized inflammatory cell infiltration, fibrous tissue hyperplasia, and two intranuclear inclusions in macrophages (green arrows) of lung tissue (HE, ×400); C: Immunohistochemistry shown CMV inclusion bodies is brown (IHC, ×400); D: The pseudohyphae and fungal spores with segregation and branching at acute angles under local magnification, its morphology consistent with aspergillus (red arrows) (PAS, × 400); E: The fungus is blackish brown (blue arrow), (PAS and Hexamethylamine silver staining, × 400).
Figure 3
Pathomorphologic and immunohistochemical features of CMV infection in submandibular lymph nodes and esophageal mucosa A: Viral inclusion bodies are seen in the nuclei of multiple macrophages in submandibular lymph nodes (green arrow) (HE, × 400); B:Immunohistochemistry shown CMV positivity in figure A (IHC, ×400); C: AIDS esophageal mucosal biopsy with infiltration of inflammatory cells under squamous epithelium, and numerous viral inclusion bodies seen in the nuclei of multiple cells (green arrows) (HE, × 400); D: Immunohistochemistry shown CMV positive expression in figure C (IHC, ×400).
Figure 4
Histopathologic and immunohistochemical characteristics of CMV infection in transverse colon mucosal Inflammatory cell infiltration and an eosinophilic inclusion body in the nucleus are seen (green arrow) in the mucosal interstitium of the transverse colon.(HE, ×400); B: Foci of intestinal mucosal inflammatory necrosis, small focal eosinophilic changes were seen (yellow arrows) (HE, ×400); C, D: Showing Figure A, B CMV immunohistochemistry the amount of intranuclear inclusion bodies increased significantly and became more clearly visible (IHC, ×400).
Figure 5
Pathomorphology and special staining features of colonic mucosa combined with Talaromyces marneffei and Mycobacterium tuberculosis infections (×1 000) A: Fungal spores were detected in foam cells and tissue interstitial space in the intestinal mucosa, see magnified picture in the upper right corner (HE, ×1 000); B: PAS stain shown that fungal spores are salami like with separation in the middle, its morphology is consistent with Talaromyces marneffei (PAS, × 1 000); C: Talaromyces marneffei is in dark brown color (PAS and Hexamethylamine silver staining, ×1 000); D: Intestinal mucosal antacid stai-ning shown mycobacteria in red color (Ziehl-Neelsen, ×1 000).
[1] | ZHAO M, ZHUO C, LI Q, et al. Cytomegalovirus (CMV) infection in HIV/AIDS patients and diagnostic values of CMV-DNA detection across different sample types[J]. Ann Palliat Med, 2020, 9(5):2710-2715. |
[2] | 中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中国艾滋病性病, 2021, 27(11):1182-1201. |
Acquired Immunodeficiency Syndrome and Hepatitis C Professional Group, Society of Infectious Diseases, Chinese Medical Association, Chinese Center for Disease Control and Prevention. Chinese guidelines for diagnosis and treatment of human immunodeficiency virus/acquired immunodeficiency syndrome (2021 edition)[J]. Chin J AIDS STD, 2021, 27(11):1182-1201. | |
[3] | 张莉. 艾滋病合并巨细胞病毒感染特点及危险因素的研究[J]. 国际检验医学杂志, 2018, 39(3):293-295,299. |
ZHANG L. Characteristics of AIDS complicating cytomegalovirus infection and the risk factors[J]. Int J Lab Med, 2018, 39(3):293-295,299. | |
[4] |
SPIES R, JOUBERT P, CHETTY D, et al. Multisystem cytomegalovirus end-organ disease in a patient with advanced HIV[J]. S Afr J Infect Dis, 2022, 37(1):468.
doi: 10.4102/sajid.v37i1.468 pmid: 36483572 |
[5] |
SUN L, CHEN J M, YANG K, et al. Cytomegalovirus cell tropism and clinicopathological characteristics in gastrointestinal tract of patients with HIV/AIDS[J]. Diagn Pathol, 2022, 17(1):9.
doi: 10.1186/s13000-022-01193-9 pmid: 35027044 |
[6] | FANG M, LIN X, WANG C, et al. High cytomegalovirus viral load is associated with 182-day all-cause mortality in hospitalized people with human immunodeficiency virus[J]. Clin Infect Dis, 2023, 76(7):1266-1275. |
[7] | 李明远, 徐志凯. 医学微生物学[M]. 第3版. 北京: 人民卫生出版社, 2016:383-397. |
LI M Y, XU Z K. Medical microbiology[M]. 3rd ed. Beijing: People's Medical Publishing House, 2016:383-397. | |
[8] | 姜支农, 石雪迎, 周炜洵, 等. 活检标本炎症性肠病规范化病理诊断建议[J]. 中华病理学杂志, 2019, 48(2):81-86. |
JIANG Z N, SHI X Y, ZHOU W X, et al. Proposal of standardized pathological diagnosis for inflammatory bowel disease through biopsies[J]. Chin J Pathol, 2019, 48(2):81-86. | |
[9] |
GRABAR S, LE MOING V, GOUJARD C, et al. Clinical outcome of patients with HIV-1 infection according to immunologic and virologic response after 6 months of highly active antiretroviral therapy[J]. Ann Intern Med, 2000, 133(6):401-410.
doi: 10.7326/0003-4819-133-6-200009190-00007 pmid: 10975957 |
[10] | AFFANDI J S, MONTGOMERY J, BRUNT S J, et al. The immunological footprint of CMV in HIV-1 patients stable on long-term ART[J]. Immun Ageing, 2015,12:14. |
[11] | 韦林华, 张彤, 吴锋耀, 等. HAART时代HIV/AIDS住院病人机会性感染疾病谱分析[J]. 中国艾滋病性病, 2018, 24(5):454-457. |
WEI L H, ZHANG T, WU F Y, et al. Analysis of the opportunistic infections′spectrum in hospitalized patients with HIV/AIDS in the era of HAART[J]. Chin J AIDS STD, 2018, 24(5):454-457. | |
[12] | 陈永宏. HAART治疗对AIDS机会性感染的影响研究[J]. 河北医药, 2016, 38(2):218-220. |
CHEN Y H. Effect of HAART treatment on AIDS opportunistic infection[J]. Hebei Med J, 2016, 38(2):218-220. |
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