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We report a patient with newly diagnosed late-stage HIV presenting with fever, rhinosinusitis and cognitive impairment. Analysis of cerebrospinal fluid and nasal turbinate tissue confirmed cytomegalovirus (CMV) infection. CMV pp65 antigen assay conducted on peripheral blood leukocytes revealed large CMV infected mononuclear cells (diameter ∼ 50 μm) with an unusual cytoplasmic pattern of pp65 staining. These large cells were also seen in buffy coat Wright's stained smears; their size, morphology and pp65 antigen uptake pattern were consistent with CMV infected cytomegalic endothelial cells. While CMV sinus infections are occasionally encountered in AIDS patients, this is the first report to document CMV infection of the nasal mucosa with secondary sinusitis and chronic suppurative otitis media. Furthermore, the detection of circulating cytomegalic cells is described--a rare finding with pathological and clinical significance in immunocompromised patients with CMV disease. Copyright © 2015 Elsevier B.V. All rights reserved.


Siddharth Sridhar, Iris W S Li, Sally C Y Wong, Kwok-Yung Yuen. Circulating cytomegalic cells in a patient with advanced HIV presenting with cytomegalovirus rhinosinusitis. Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology. 2015 Apr;65:87-9

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PMID: 25766996

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