PMC8127748_01
Cytomegalovirus (CMV) viral inclusion (black arrow points to the infected cells with nuclear inclusion). CMV infected cell is enlarged (cytomegalic), containing basophilic intranuclear inclusion (Cowdry body) surrounded by a clear halo, giving the appearance of an owl's eye (hematoxylin and eosin stain at 600x original magnification).
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She was found to have elevated CMV polymerase chain reaction in the blood (679 198 IU/mL) and spinal fluid (>2 000 000 IU/mL), as well as biopsy-proven CMV hepatitis (Figure 1).
Spotty to confluent hepatocyte necrosis (dashed line), hepatocellular swelling (A, hematoxylin and eosin stain at 400x original magnification) and cholestasis in the lobule, black arrows (B, hematoxylin and eosin stain at 200x original magnification).
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A liver biopsy, obtained shortly prior to death, showed confluent hepatocyte necrosis (Figure 2) and intrahepatic protozoa (~1-2 microm in diameter), consistent with Toxoplasma bradyzoites (Figure 3).
Intrahepatic protozoa (~1-2 microm in diameter) consistent with Toxoplasma cyst with bradyzoites, black arrow (hematoxylin and eosin stain at 600x original magnification).
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A liver biopsy, obtained shortly prior to death, showed confluent hepatocyte necrosis (Figure 2) and intrahepatic protozoa (~1-2 microm in diameter), consistent with Toxoplasma bradyzoites (Figure 3).
Immunohistochemical stain for Toxoplasma gondii confirms the diagnosis. It shows multiple intrahepatocytic protozoa that are arranged individually, consistent with Toxoplasma tachyzoites infection, black box/arrow (immunohistochemistry at 200x; inset box at 630x original magnification).
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Immunohistochemical stain for Toxoplasma, performed by the CDC, confirmed Toxoplasma infection (Figure 4).