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Table 1 CMV appendicitis cases reported in HIV-infected patients from 1988 to present

From: Cytomegalovirus immune reconstitution inflammatory syndrome manifesting as acute appendicitis in an HIV-infected patient

Reference/Year Age/Gender ARVs at diagnosis (duration) Clinical syndrome Diagnosis Treatment Outcome
[6] 1989 35 yo M No Abdominal pain, TTP in RLQ, rebound Histology Laparoscopic appendectomy with IV and oral antibiotics Abscess; Recovery then readmission and death 25 days later
[7] 1988 (Published in 1991) 50 yo M No Fever, RLQ pain, rebound tenderness, RLQ mass Histology Exploratory laparotomy; IV antibiotics ganciclovir 5×/week (“maintenance therapy”) when CMV confirmed Periappendiceal abscess; Recovery
[8] 1990 28 yo M Yes (5 weeks) RLQ pain, rebound Histology Exploratory laparotomy, IV antibiotics with appendectomy Recovery
[9] 1991 31 yo M No Fever, RLQ pain, rebound, guarding Histology, in situ hybridization with CMV probes Appendectomy Recovery
[10] 1993 38 yo M NR RLQ pain, fever TTP at McBurney’s point Histology, IHC (monoclonal anti-CMV antibody) IV antibiotics and observation; Exploratory laparotomy with appendectomy; ganciclovir Recovery
[11] 1994 Patient 1 48 yo M NR Lower abdominal pain, fever, septic shock Histology Exploratory laparotomy with appendectomy, ganciclovir, imipenem, inotropes. Perforation; Death
[11] 1994 Patient 2 27 yo M NR Periumbilical pain, nausea, vomiting, peritoneal signs Histology, IHC Exploratory laparotomy with appendectomy Death
[12] 1995 34 yo M Yes (unknown duration) RLQ pain, fever Histology CMV PCR in WBC Laparoscopic appendectomy Recovery
[13] 1997 30 yo M NR RLQ pain, fever, nausea, vomiting Histology Appendectomy, post-op ganciclovir Recovery
[14] 1997 29 yo M NR Right sided abdominal pain Histology, immunofluorescence Appendectomy Abscess and perforation; Recovery
[15] 2004 37 yo M NR Fever, abdominal pain, rebound and guarding over RLQ Histology, immunostaining Appendectomy; IV ganciclovir Recovery
Present case 38 yo F Yes (2 weeks) RLQ pain, anorexia, nausea, fever Histology, CMV viral staining Laparoscopic appendectomy, IV antibiotics peri-operatively, valganciclovir (2 weeks) Perforation; Full recovery
  1. NR: not reported; M: male; F: female; RLQ: right lower quadrant; TTP: tenderness to palpation, IHC: immunohistochemistry. WBC: white blood cells.