Cytomegalovirus-associated supraglottic mass in a patient on immunosuppressive therapy

K R Anavi; C Nel; M J Savage-Reid; K E Adzatia; J S Nel

doi:10.7196/SAMJ.2021.v111i7.15614

In Practice

Cytomegalovirus-associated supraglottic mass in a patient on immunosuppressive therapy

K R Anavi, C Nel, M J Savage-Reid, K E Adzatia, J S Nel

Abstract

A 33-year-old woman on chronic immunosuppressive treatment for rheumatoid arthritis with a history of inhaled methamphetamine use presented with respiratory failure requiring mechanical ventilation for a prolonged period. After being given plasma exchange, pulses of methylprednisolone and a dose of cyclosporine for suspected ANCA (anti-neutrophilic cytoplasmic autoantibodies) vasculitis, she developed an obstructive supraglottic laryngeal mass that required a tracheostomy to bypass. Biopsy findings revealed the mass to be an inflammatory pseudomass secondary to cytomegalovirus (CMV). The mass resolved after several weeks of intravenous ganciclovir therapy. This is an extremely unusual presentation of localised CMV disease, with only two or three similar cases having been reported worldwide.

Authors' affiliations

K R Anavi, Division of Infectious Diseases, Department of Medicine, School of Clinical Medicine, University of the Witswatersrand, Johannesburg, South Africa

C Nel, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa

M J Savage-Reid, Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; National Health Laboratory Service, Charlotte Maxeke Academic Hospital, Johannesburg, South Africa

K E Adzatia, Department of Otorhinolaryngology. Chris Hani Baragwanath Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

J S Nel, Division of Infectious Diseases, Department of Medicine, School of Clinical Medicine, University of the Witswatersrand, Johannesburg, South Africa