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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Disseminated CMV infection and HLH in a patient with well-controlled HIV and ulcerative colitis
  1. Beatrice Clare Cockbain1,
  2. Borja Mora Peris2,
  3. Aula Abbara3,
  4. Chun Wah So4 and
  5. Graham Cooke2,3
  1. 1 Department of Immmunology and Infection, Barts Health NHS Trust, London, UK
  2. 2 Department of Genitourinary Medicine and HIV, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Department of Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
  4. 4 Department of Radiology, Northwick Park Hospital, Harrow, London, UK
  1. Correspondence to Dr Beatrice Clare Cockbain, beatriceclare.cockbain{at}bartshealth.nhs.uk

Abstract

We present a case of haemophagocytic lymphohistiocytosis (HLH) in the context of disseminated cytomegalovirus (CMV) viraemia in a 50-year-old man with well-controlled HIV infection and ulcerative colitis (UC), for which he was receiving azathioprine. Peak CMV viral load was 371 000 copies/ml with evidence of end-organ CMV in the lungs and colon. A bone marrow biopsy showed evidence of haemophagocytosis of platelets, neutrophils and erythrocytes. The azathioprine was stopped, and he received intravenous ganciclovir and corticosteroids with suppression of the CMV viral load and resolution of the HLH.

  • infectious diseases
  • HIV / AIDS
  • inflammatory bowel disease
  • immunology
  • pathology

http://dx.doi.org/10.1136/bcr-2018-227916

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    Footnotes

    • Contributors All authors contributed to original idea and design of the paper. BCC prepared and wrote all drafts, including revisions. GC oversaw the writing, with AA, CWS and BMP editing and providing specialist input to the paper. BMP contacted the patient and liaised with the pathology department to obtain histology images.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Correction notice This article has been corrected since it was first published Online. The year in the sentence "For his UC, which had been diagnosed…" has been changed from 15 to 5 years.

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