Disseminated Cytomegalic Inclusion Disease in an Adult: With Primary Refractory Anemia and Transfusional Siderosis

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Abstract
In a 20-yr.-old woman generalized cytomegalic inclusion disease (infection with the salivary gland virus) developed following primary refractory anemia which had been therapeutically supported by 135 blood transfusions. The "owl''s-eye" intranuclear inclusions, nuclear membrane orbital bodies and the peripherally placed cytoplasmic inclusional structures are identical to the viral inclusions found in "inclusion disease of infancy." The viral inclusions in this case were associated with extensive focal necroses of the liver, adrenals and pancreas. Transfusional siderosis and primary refractory anemia were other dominant pathologic findings. This is the 4th example of this viral infection in an adult; the 3 previously reported examples were associated with enteritis, with viral pneumonitis and avitaminosis, and with leukemia treated with aminopterin. Several possible pathogenetic mechanisms are suggested for this viral infection; a dormant virus reawakened as a result of altered cellular metabolism, or the introduction of the virus into a non-carrier, by one or more transfusions producing widespread necrotizing viral tissue damage.