Document 0246
 DOCN  M9590246
 TI    Cytomegalovirus causing appendicitis in an HIV positive patient.
 DT    9509
 AU    Hammett RJ; Edwards R; Kotsiou G; Pigott P; HIV Medicine Unit Royal
       North Shore Hospital, University of; Sydney, St. Leonards, N.S.W.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:278 (unnumbered poster).
       Unique Identifier : AIDSLINE ASHM6/95291853
 AB    Cytomegalovirus (CMV) infection of the gastrointestinal tract is well
       described in patients with HIV infection, however CMV infection
       presenting as acute appendicitis has been described in only a few
       instances. We present a case of CMV appendicitis in an HIV positive
       patient without previous CMV infection. The patient was a 43 year old
       male who was diagnosed as HIV positive in 1993. He had not had any AIDS
       defining illnesses. He had previously been CMV IgM negative. His CD4
       cell count in March 1994 was 4 cells/cubic mm. On 12/4/94 the patient
       presented to the outpatients department with a 2 day history of colicky
       lower abdominal pain, anorexia, nausea and vomiting. On examination he
       was afebrile but had a firm tender abdomen with guarding and rebound in
       the right iliac fossa. The patient's white cell count (WCC) was 9.0 x
       1000/ul (neutrophils 93%), electrolytes and renal and hepatic function
       tests were normal. Abdominal x-rays showed dilated loops of small bowel
       with numerous fluid levels. The patient became febrile. An infectious
       colitis was thought to be the cause of the patients presentation and he
       was initially treated with intravenous (i.v.) antibiotics and fasted. A
       CT scan performed the next day revealed four intraperitoneal collections
       and inflammation in the region of the caecum. The patient remained on
       intravenous antibiotics for a further 8 days but failed to improve. He
       underwent laparotomy and the free fluid in the peritoneal cavity was
       drained, and a swollen perforated appendix removed. Histological
       examination of the appendix revealed acute suppurative appendicitis.
       Immunoperoxidase staining revealed the presence of intracellular CMV
       inclusions within the wall of the appendix. The patient remained on i.v.
       antibiotics for a further 72 hours, and was discharged fourteen days
       after admission. This case describes an unusual presentation of CMV
       infection in a patient with HIV, and demonstrates the diagnostic
       difficulty associated with appendicitis in this setting.
 DE    Adult  Appendectomy  Appendicitis/*DIAGNOSIS/ETIOLOGY/SURGERY
       AIDS-Related Opportunistic Infections/*DIAGNOSIS/SURGERY  Case Report
       Cytomegalovirus Infections/*DIAGNOSIS/SURGERY  Human  HIV
       Seropositivity/COMPLICATIONS/*DIAGNOSIS  Intestinal
       Perforation/DIAGNOSIS/SURGERY  Male  Rupture, Spontaneous  MEETING
       ABSTRACT

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