Cytomegalovirus infection of the nasopharynx

Abstract

This report describes a case of cytomegalovirus (CMV) infection of the nasopharynx. A 47 year old man presented with a nasopharyngeal mass of one month's duration. The patient had a history of pneumonia one month previously. Sinus computed tomography incidentally picked up a nasopharyngeal mass. The initial biopsy showed lymphoid hyperplasia. Repeated nasopharyngoscopy showed a prominent central nasopharyngeal mass without ulceration. Histology of the nasopharyngeal biopsy revealed several enlarged epithelial cells with characteristic CMV cytopathic changes. An immunohistochemical study, using a monoclonal IgG antibody against a CMV antigen, confirmed CMV infection. The patient's nasopharyngeal mass decreased in size gradually on follow up. To the best of our knowledge, this is the first reported case of CMV infection of the nasopharynx in the English literature. This disease entity should be considered in those patients presenting with nasopharyngeal mass, biopsy negative for malignancy, and no underlying immunosuppression or immunodeficiency.

Figure 1

Direct nasopharyngoscopy view demonstrating the prominent nasopharyngeal mass with abundant secretion.

Figure 2

(A) The nasopharyngeal biopsy demonstrating large epithelial cells with both nuclear and cytoplasmic enlargements and characteristic basophilic intranuclear and intracytoplasmic inclusion bodies (haematoxylin and eosin; original magnification, ×400). (B) Immunohistochemistry using a monoclonal antibody against cytomegalovirus antigen highlighting the enlarged epithelial cells (original magnification, ×200).