a autopsy case of AIDS with small intestinal perforation caused by CMV enterocolitis *
Cytomegalovirus（CMV）infection is found in about 60% of autopsies of acquired immune deficiency syndrome（AIDS）patients and thus it is the most common opportunistic infection in AIDS. We report a case of small intestinal perforation caused by CMV enterocolitis, including the dissection view. The patient was a 63-year-old man, who visited a doctor because of fever and dyspnea. Antibiotics were administered, but the symptoms persisted. Interstitial pneumonia was suspected at another hospital, and he was treated with a combination of an adrenal cortical steroid and trimethoprim-sulfamethoxazole combination, but the symptoms were exacerbated. After tracheal intubation, he was transported to our hospital and underwent emergency surgery because free air had been detected in his abdominal cavity on a thoraco-abdominal image. We found a perforation in his ileum and removed a 4.2 cm region surgically. The result of immunostaining of an excision specimen led to a diagnosis of CMV enterocolitis. A human immunodeficiency virus （HIV）-1 antibody test in the pre-operative examination was positive. The HIV-1 RNA level was 32,000 copies/mL and CD4 positive cells were drastically reduced to 6/μL. As pneumocystis DNA was detected in his bronchoalveolar lavage fluid, he was diagnosed with AIDS, and treated for pneumocystis pneumonia （PCP） and CMV enterocolitis. His respiratory failure progressed however, and he died the eleventh hospital day. The dissection view revealed the main lesions to be CMV pneumonia and PCP, with sublesions of ascitic fluid and pleural effusion. CMV was detected in the myocardium, adrenal gland, spleen, esophagus, stomach, small intestine, and large intestine. The immediate cause of death was respiratory failure due to pneumonia. The HIV infection in this case should have been suspected earlier from his anamnesis and symptoms, and it shows the importance of diagnosing HIV infection before AIDS onset. (Accepted on October 16, 2009)
