Table 1 CMV appendicitis cases reported in HIV-infected patients from 1988 to present
Reference/Year | Age/Gender | ARVs at diagnosis (duration) | Clinical syndrome | Diagnosis | Treatment | Outcome |
|---|---|---|---|---|---|---|
[6] 1989 | 35 yo M | No | Abdominal pain, TTP in RLQ, rebound | Histology | Laparoscopic appendectomy with IV and oral antibiotics | Abscess; Recovery then readmission and death 25 days later |
[7] 1988 (Published in 1991) | 50 yo M | No | Fever, RLQ pain, rebound tenderness, RLQ mass | Histology | Exploratory laparotomy; IV antibiotics ganciclovir 5×/week (“maintenance therapy”) when CMV confirmed | Periappendiceal abscess; Recovery |
[8] 1990 | 28 yo M | Yes (5 weeks) | RLQ pain, rebound | Histology | Exploratory laparotomy, IV antibiotics with appendectomy | Recovery |
[9] 1991 | 31 yo M | No | Fever, RLQ pain, rebound, guarding | Histology, in situ hybridization with CMV probes | Appendectomy | Recovery |
[10] 1993 | 38 yo M | NR | RLQ pain, fever TTP at McBurney’s point | Histology, IHC (monoclonal anti-CMV antibody) | IV antibiotics and observation; Exploratory laparotomy with appendectomy; ganciclovir | Recovery |
[11] 1994 Patient 1 | 48 yo M | NR | Lower abdominal pain, fever, septic shock | Histology | Exploratory laparotomy with appendectomy, ganciclovir, imipenem, inotropes. | Perforation; Death |
[11] 1994 Patient 2 | 27 yo M | NR | Periumbilical pain, nausea, vomiting, peritoneal signs | Histology, IHC | Exploratory laparotomy with appendectomy | Death |
[12] 1995 | 34 yo M | Yes (unknown duration) | RLQ pain, fever | Histology CMV PCR in WBC | Laparoscopic appendectomy | Recovery |
[13] 1997 | 30 yo M | NR | RLQ pain, fever, nausea, vomiting | Histology | Appendectomy, post-op ganciclovir | Recovery |
[14] 1997 | 29 yo M | NR | Right sided abdominal pain | Histology, immunofluorescence | Appendectomy | Abscess and perforation; Recovery |
[15] 2004 | 37 yo M | NR | Fever, abdominal pain, rebound and guarding over RLQ | Histology, immunostaining | Appendectomy; IV ganciclovir | Recovery |
Present case | 38 yo F | Yes (2 weeks) | RLQ pain, anorexia, nausea, fever | Histology, CMV viral staining | Laparoscopic appendectomy, IV antibiotics peri-operatively, valganciclovir (2 weeks) | Perforation; Full recovery |