Cytomegalovirus-Associated Severe Fatal Necrotizing Pancreatitis in a Patient with Interstitial Pneumonitis Treated with Steroids. An Autopsy Case

摘要

Context An autopsy case ofcytomegalovirus (CMV) associated with fatal severe pancreatitis is reported. Casereport A 76-year-old man presented with high fever and was admitted to ourhospital for evaluation. Imaging modalities, including chest X-ray, CT and MRI,revealed interstitial pneumonia. Blood laboratory tests showed positiveanti-nuclear antigen (x80), but collagen diseases were not identified. Thepatient was treated with steroids (prednisolone 30 mg/day). Two months later,the patient developed acute abdominal pain. Serum laboratory tests revealed an elevatedamylase level (1,296 IU/L), and CT demonstrated acute pancreatitis. The patientdied of multiple organ failure from the acute pancreatitis three days after theonset of the acute pancreatitis. An autopsy revealed severe necrotizing acutepancreatitis. Numerous large inclusions of CMV were found in the acinar andductal cells of the pancreas. Numerous CMV inclusions were also seen in thedegenerated and necrotic pancreatic acinar cells. CMV-infected cells wereimmunohistochemically positive for CMV antigen, CMV early antigen and CMV lateantigen, indicating active replication and regression of CMV. ConclusionThe findings strongly suggest that severe CMV infection can occur after steroidadministration, and that CMV infection can be the cause of severe fatal acutenecrotizing pancreatitis.