PMC7485475_01
CT imaging. a) High resolution CT scan of the chest, showing extensive areas of ground-glass opacity, with strands of consolidation and left pleural effusion. b) Coronal arterial phase CT image shows areas of reduced parenchymal perfusion (arrow) and large peripancreatic collections (arrowhead).
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The patient was severely hypoxemic (paO2/FiO2 less than 100), chest X-ray, and computerized tomography (CT) (Figure 1a) revealed bilateral interstitial pneumonia. The patient also underwent a CT-scan of the abdomen, which showed pancreatitis with a non-homogeneous pattern of the pancreatic head and peripancreatic fluid collection (Figure 1b).
a) Upper endoscopy showing multiple large and confluent ulcers in the first and second portions of the duodenum with initial re-epithelialization and an ischemic-like pattern. b) Duodenal ulcer biopsy H&E staining. c) High power view of the area highlighted in <<a>> H&E: large basophilic CMV inclusions within endothelial cells in the granulation tissue (arrows). d) High power view Immunohistochemistry showing CMV-positive cells.
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After hemodynamic stabilization with intravenous fluids and transfusion with two units of red blood cells, an upper endoscopy was performed, which showed multiple large and confluent ulcers in the first and second portions of the duodenum (Figure 2a), suggesting a Cytomegalovirus (CMV) duodenitis. CMV-DNA (6,080 IU/mL titer) and by duodenal histopathological findings (Figure 2b,c,d). CMV serologic test showed positive IgG (154 U/mL; positive >= 14 U/mL) and borderline IgM at diagnosis.