Vesicovaginal fistula associated with cytomegalovirus infection in an HIV-infected patient.

BACKGROUND

Cytomegalovirus (CMV) can cause multisystem disease in human immunodeficiency virus (HIV)-infected patients. An association with a vesicovaginal fistula has not previously been reported.

CASE: An HIV-infected African-American female presented with back pain, swelling and paralysis of her lower extremities and continuous leakage of urine. Fundoscopic examination was typical of CMV retinitis. Doppler and CT studies showed bilateral deep vein thrombosis and bilateral pulmonary emboli, respectively. Anticoagulant therapy was started, and a Greenfield filter was placed. An examination under anesthesia and cystoscopy showed extensive vulvar and rectal condylomata, a large, necrotic, anterior vaginal mass, and a large vesicovaginal fistula. All necrotic tissue was resected and the biopsies taken identified CMV cytopathic effect.

CONCLUSION

Vesicovaginal fistula in an immunocompromised individual may be a local manifestation of systemic CMV disease.