AIDS presenting as cytomegalovirus cystitis

Haemorrhagic cystitis due to cytomegalovirus in a patient with AIDS

Background

Cytomegalovirus-related infections are commonly seen in immunocompromised patients. However, haemorrhagic cystitis is an exceptionally rare associated manifestation. We present an unusual case of cytomegalovirus-related haemorrhagic cystitis in a patient with acquired immune deficiency syndrome (AIDS).

Case presentation

A 33-year-old HIV-positive female presented with acute gross haematuria and suprapubic pain. Cystoscopy revealed features suggestive of haemorrhagic cystitis with clots in the bladder and an ulcerative lesion on the left lateral wall which was biopsied. Histology demonstrated the presence of enlarged cells containing eosinophilic intranuclear and ill-defined amphophilic intracytoplasmic inclusions. Immunohistochemistry was positive for cytomegalovirus.

Conclusion

This case appears to be the first of its kind reported in South Africa highlighting the importance of considering cytomegalovirus as a potential infectious aetiology in AIDS patients with haematuria. Bladder irrigation with normal saline with or without clot evacuation combined with Ganciclovir are associated with good outcome.

Interstitial cystitis in men

Interstitial cystitis is an uncommon disease reported predominantly in females. Recently we were involved in the management of 4 men who had the clinical, endoscopic and pathological features consistent with the diagnosis of interstitial cystitis. The rarity of occurrence of the disease in males prompted us to report these cases.

Genitourinary manifestations of the acquired immunodeficiency syndrome

As the number of HIV-1 infected individuals and AIDS patients continues to increase, more cases involving the genitourinary tract will be encountered. Often, genitourinary manifestations will be the initial presentation of AIDS. Proper diagnosis will require awareness and a high index of suspicion. In addition to routine cultures, opportunistic infections with unusual organisms will require staining for fungi and acid-fast bacilli. Repeat cultures of blood, urine, seminal fluid, and abscess cavities may be required to establish a diagnosis. Prolonged courses of antibiotic treatment for prophylaxis and for relapses are usually required. Clinical understaging and rapid progression of tumors distinguish HIV-1-associated malignancies involving the genitourinary tract. Treatment for these malignancies will depend on the stage of HIV-1 infection. Any concomitant drug therapy and evidence of malnutrition will be important factors in selecting the proper timing and mode of therapeutic intervention. Although AIDS predominantly affects individuals between 30 and 50 years of age, an increasing percentage of patients over 50 years of age are being diagnosed. Common risk factors for acquisition of HIV include homosexuality or bisexuality and transfusion of blood or blood products. For the urologist, it is important to recognize that older patients more frequently present with AIDS at the time of diagnosis of HIV infection. A more rapid course of deterioration and high mortality is noted in this population. Clearly, protocols including surveillance, dosing regimens, and surgical intervention will need to be established and clarified to treat an anticipated increasing number of affected patients. In addition, it appears that adequate adherence to universal precautions is far from being achieved. Close monitoring and active surveillance of infection control may be needed to improve compliance.

Lethal cytomegalovirus adrenalitis in a case of AIDS

The clinico-pathologic report of a case of cytomegalovirus (CMV) necrotizing adrenalitis arising in an intravenous drug-abuser and HIV-infected young is presented. CMV urinary tract infection, genital Kaposi's, and demyelinating changes in central nervous system were associated findings.

Toxoplasma cystitis associated with acquired immunodeficiency syndrome

Ante-mortem diagnosis of vesical toxoplasmosis in a patient with acquired immunodeficiency syndrome (AIDS), was made by cystoscopic examination and biopsy of the bladder. Vesical biopsies can be helpful in determining appropriate therapy for AIDS patients with urinary tract involvement/disease.

Haematuria frequency syndrome in patients with positive HIV serology: observations in Zambia

Observations are presented on 9 patients recently treated in the University Teaching Hospital, Lusaka, Zambia, for painful urinary frequency, suprapubic pain and microscopic and/or macroscopic haematuria without any demonstrable urinary tract infection. At cystoscopy the bladder mucosa of all patients depicted a highly characteristic, uniformly congested appearance with no demonstrable ulcers; there was no significant reduction in bladder capacity. The histological appearance was essentially non-specific in type with an apparent resemblance to that of interstitial cystitis; mast cells were, however, absent in all specimens. An important feature common to all patients was an associated HIV infection; cytochemistry of the bladder tissue did not reveal an associated cytomegalovirus cystitis. No such case was observed in Zambia prior to the advent of HIV infection and the phenomenon was observed only in seropositive patients. It has been suggested that the virus is likely to be associated with the genesis of the bladder symptoms. The natural history of the disorder, its incidence among the seropositive individuals and its pathogenesis remain unclear.