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Resident PGY 1
Henry Ford Hospital
Discussion: We present a case of disseminated CMV manifesting as cutaneous eruptions, viremia, retinitis, and encephalopathy in an immunocompromised patient. This patient was admitted for multifocal pneumonia, but continued to spike fevers and remained encephalopathic even after resolution of the pneumonia. Despite extensive evaluation for other infectious etiologies he failed to improve until he was placed on ganciclovir. Encephalopathy in HIV patients requires evaluation for Toxoplasma, primary CNS lymphoma, progressive multifocal leukoencephalopathy, and also HIV encephalopathy. This patient had never been on anti-retroviral therapy, and imaging was concerning for HIV encephalopathy; however, he had drastic improvement in mentation upon initiating ganciclovir therapy. Disseminated CMV is not uncommon in AIDS patients, but is traditionally associated with visceral organ involvement (retinitis, colitis, meningitis, and hepatitis). Cutaneous manifestations, and encephalopathy are less common presentations. Conclusion: Due to the immunocompromised nature of AIDS patients, there are multiple infectious etiologies that can present with encephalopathy, and cutaneous manifestations. As such, a thorough history, physical exam, and a systematic approach is necessary to identify the cause. Disseminated CMV can present with encephalopathy as well as cutaneous lesions that can be co-infected with HSV 1 and 2. This patient showed dramatic improvement in mentation and skin lesions while being on IV ganciclovir.
Modi, Krishna; Omari, Ali; and Abreu-Lanfranco, Odaliz, "An Atypical Presentation of Disseminated CMV in an Immunocompromised Patient" (2019). Case Reports. 62.