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/microL with an HIV viral load of 2.6 x 10(5) 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 patient's CD4-positive cells increased to 130/microL 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.