Cytomegalovirus (CMV) Infection, Non-congenital

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Background    Neuroimaging    Gross Pathology    Histopathology & Immunohistochemistry

Differential Diagnosis    Reference

BACKGROUND AND CLINICAL INFORMATION: Head

Clinical features:

• Almost always associated with immunosuppression such as: AIDS, transplantation.

• CMV is the most common opportunistic infection in AIDS patients especially in homosexual patients. [Congenital CMV infection]

Anatomic locations: Scattered  foci in gray matter. Subependymitis is typically seen.

NEUROIMAGING: Head

GROSS PATHOLOGY: Head

HISTOPATHOLOGY AND IMMUNOHISTOCHEMISTRY: Head

Characteristic large nuclei with "bull eye" nuclear inclusion. Small cytoplsmic inclusions may also be present and are best seen with Romanovsky stain in smear.

Low grade encephalitis is characterized by the presence of scattered microglial nodules, chiefly in gray matter. CMV inclusion bodies can be seen in these nodules occassionally.

Viruses can be found in astrocytes, macrophages, and occassionally neurons.

CMV infects the ependymal and subependymal region and causes massive necrosis (necrotizing ventriculoencephalitis).

DIFFERENTIAL DIAGNOSIS: Head