Cytomegalovirus-Associated Pancreatitis in Acquired Immunodeficiency Syndrome

Cytomegalovirus (CMV)-associated acute pancreatitis is a rare condition1’2, although CMV inclusions in the pancreas may be seen in autopsy series of patients with AIDS3’4. CMV pancreatitis in these patients may present in an atypical fashion, and diagnosis may be obscured by accompanying diseases. We describe here a new case of this entity, in which pancreatic damage persisted for four months and the clinical picture, although compatible with acute pancreatitis at the beginning, was masked by superimposed disease during the clinical course. A fifty-year-old was admitted to the Hospital with a four-day history of disorientation, mental obtundation and continuous vomiting. She had never consumed any kind of drugs, including ethanol, and her only sexual partner also denied other sexual contacts. She had been operated on (hysterectomy) three years before in another hospital (before Spanish law made obligatory HIV-antibody determination in blood donors). At that time she received a blood transfusion. Physical examination on admission revealed a pale, undernourished and confused middle-aged woman, with profuse sweating and a blood pressure of 80/50 mm Hg. Examination of the oral cavity showed candidiasis. Chest radiography, lumbar puncture, cerebral computed tomography (CT), and blood and urine cultures at admission were negative, and routine urine and blood analysis were normal except for the following" serum amylase 1288 U/I, serum albumin 30 g/l, serum AST 89 U/I, ALT 98 U/I, serum glucose 411 mg/dl (22.8 mmol/1), LDH 558 U/I, platelet count, 87 109/1 (87000/mm3). Abdominal ultrasound examination revealed a normal but hypo-echogenic pancreas, normal bile ducts, and absence of gallstones. Treatment with amphotericin, parenteral nutrition, cephotaxime and netilmicin led to an improvement in her general condition; the patient began to eat, the serum amylase on the fourth day had returned to normal (187 U/I). On the 10th day she complained of fever and diarrhoea. Anaemia (haemoglobin 81 g/l) and leucopenia