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Cytomegalovirus disease presenting as a focal brain mass: report of two cases
P P Huang1, A A McMeeking, M J Stempien
1Department of Neurosurgery, New York University Medical Center, New York, USA.
Insights
Cytomegalovirus (CMV) infection can rarely cause enhancing intracranial lesions in patients with human immunodeficiency virus (HIV). Postmortem analysis revealed CMV inclusion bodies in necrotizing lesions, highlighting its potential as a differential diagnosis.
Area of Science:
- Neuroscience
- Infectious Diseases
- Radiology
Background:
- Intracranial lesions in human immunodeficiency virus (HIV)-positive individuals often include toxoplasmosis, lymphoma, and progressive multifocal leukoencephalopathy.
- Cytomegalovirus (CMV) central nervous system infections are challenging to diagnose and infrequently manifest as contrast-enhancing mass lesions on radiographic studies.
Observation:
- Two HIV-positive patients presented with progressive focal neurological deficits.
- Radiographic imaging revealed solitary, contrast-enhancing lesions in the basal ganglia and cerebellar hemisphere, respectively.
- Despite treatment, one patient died; the other died without diagnosis before postmortem examination.
Findings:
- Postmortem examinations of both patients showed necrotizing lesions.
- Histopathological analysis revealed diffuse infiltration of histiocytes containing eosinophilic cytomegalovirus inclusion bodies.
Implications:
- Cytomegalovirus infection should be included in the differential diagnosis for HIV-positive patients presenting with enhancing intracranial lesions.
- This underscores the importance of considering less common opportunistic infections in the context of advanced HIV disease.
- Early consideration of CMV may guide diagnostic and therapeutic strategies, potentially improving patient outcomes.
Objective And Importance:
Although the differential diagnosis of intracranial lesions in patients who have tested positive for human immunodeficiency virus is extensive, toxoplasmosis, lymphoma, and progressive multifocal leukoencephalopathy comprise approximately 90% of such cases. Cytomegalovirus infection of the central nervous system may be difficult to diagnose and rarely presents as mass lesions revealed by radiographic studies.
Clinical Presentation:
Two patients who had tested positive for human immunodeficiency virus presented with progressive focal neurological deficits. Radiographic studies revealed solitary contrast-enhancing lesions in the right basal ganglia and right cerebellar hemisphere, respectively.
Intervention:
The first patient underwent a stereotactic biopsy but died despite appropriate therapy. The second patient died without tissue having been obtained for diagnosis. Postmortem examinations revealed necrotizing lesions with diffuse areas of infiltrating histiocytes containing eosinophilic cytomegalovirus inclusion bodies.
Conclusion:
Although rare, cytomegalovirus infection should be considered in patients who have tested positive for human immunodeficiency virus and who present with enhancing intracranial lesions.