Cytomegalovirus-Associated Pancreatitis in a Person With Hiv

Gastrointestinal disease due to cytomegalovirus (CMV) is commonly associated with AIDS. Pancreatic involvement, though uncommon, may manifest with abdominal pain, elevated amylase/lipase, and imaging abnormalities. Diagnosis is complex, requiring demonstration of virus in pancreatic tissue. A 42-year-old incarcerated man with a 10-year history of HIV infection off ART, CD4 10 cells/mm³, was admitted for left flank abdominal pain with hyporexia, nausea, vomiting, and a history of pasty diarrhea resolved by admission, without other symptoms. During the etiological investigation, abdominal magnetic resonance imaging revealed cystic pancreatic lesions with thick and heterogeneous characteristics. The search for viral genetic material using polymerase chain reaction (PCR) from the endoscopic biopsy sample of the pancreatic cyst was positive for CMV. Tests for tuberculosis were negative, and there was no growth of fungi or bacteria in cultures. Blood CMV PCR was positive (> 39,000 copies/mL) and serum amylase persistently elevated (> 400 U/L). CMV pancreatitis was diagnosed and intravenous ganciclovir started for 14 days. One month later, abdominal pain recurred with imaging evidence of increased pancreatic cysts; ganciclovir was re-initiated at a higher dose for 30 days. At treatment completion, blood CMV PCR was negative with normalization of amylase and radiologic improvement. Despite being rare, CMV pancreatitis should be considered in immunosuppressed patients with compatible presentations as a differential diagnosis for pancreatic cystic lesions. In this case, the diagnosis was confirmed by identifying the pathogen in the pancreatic cyst sample, which allowed treatment to be guided. However, a definitive therapeutic response required higher doses and a longer duration of antiviral therapy.