十二指腸乳頭部腫瘍が疑われた HIV 感染合併 CMV 感染症の 1 例

• 南 留美

  国立病院機構九州医療センター内科・臨床研究センター

• 高濱 宗一郎

  国立病院機構九州医療センター内科・臨床研究センター

• 中嶋 恵理子

  国立病院機構九州医療センター内科・臨床研究センター

• 山本 政弘

  国立病院機構九州医療センター内科・臨床研究センター

書誌事項

タイトル別名

• CMV-induced Duodenal Papillitis in a Patient with HIV-1 Infection
• 症例 十二指腸乳頭部腫瘍が疑われたHIV感染合併CMV感染症の1例
• ショウレイ ジュウニシチョウ ニュウトウブ シュヨウ ガ ウタガワレタ HIV カンセン ガッペイ CMV カンセンショウ ノ 1レイ

抄録

We present herein a case report of a 59-year-old patient with HIV-1 infection who developed a CMV-induced pseudotumor of the duodenum. The patient presented with oral pain and dysphagia. Physical examination revealed oral thrush. An EIA and a Western blot assay for antibodies to HIV were positive. His CD4-positive lymphocyte count was initially 49/μL with an HIV viral load of 2.6×10⁵ copies/mL. Cytomegalovirus (CMV) reactivation was detected with the CMV antigenemia assay. He had CMV retinitis in both eyes with unilateral blurring. An endoscopic study revealed candida esophagitis, and a tumor-like lesion with an irregular ulcer at the papilla of Vater. Histological and immunohistochemical studies revealed a CMV-induced pseudotumor and severely inflamed duodenal mucosa with infiltration of CMV-positive cells. The patient was treated with oral valganciclovir and fluconazole for three weeks. As the oral thrush and retinitis showed improvement, he began antiretroviral therapy (ART), consisting of raltegravir and TDF/FTC. One month later the patientʼs CD4-positive cells increased to 130/μL and the level of HIV-RNA decreased to 160 copies/mL. The CMV retinitis had transiently worsened because of an ART-induced inflammatory response, immune reconstitution inflammatory syndrome (IRIS). Six months after the ART initiation, an endoscopic study revealed that the esophagitis and the lesion at the papilla had improved. Biopsy showed no CMV-positive cells in the epithelium. The patient was now in a relatively healthy condition. CMV-induced pseudotumors of the duodenum are rare, and sometimes resemble malignancy. However, because this tomor responds to medical treatment physicians treating severely immunocompromised patients should be aware of its presentation and treatment.

収録刊行物

• 感染症学雑誌

  感染症学雑誌 87 (4), 441-445, 2013

  一般社団法人 日本感染症学会

キーワード

• HIV
• cytomegalovirus
• duodenitis

詳細情報

• CRID: 1390282680026303616
• NII論文ID: 10031201447
• NII書誌ID: AN00047715
• DOI: 10.11150/kansenshogakuzasshi.87.441
• ISSN: 1884569X
• ISSN: 03875911
• NDL書誌ID: 024820050
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I024820050
• Web Site: https://search.jamas.or.jp/link/ui/2013351725
• 本文言語コード: ja
• データソース種別:
  • JaLC
  • NDL
  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可