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Central Diabetes Insipidus due to Cytomegalovirus Infection of the Hypothalamus in a Patient with Acquired Immunodeficiency Syndrome: A Clinical, Pathological, and Immunohistochemical Case Study

Departments of Medicine (A.M.M., M.C.C.) and Pathology (D.G.T., G.H.C.), SUNY Upstate Medical University, Syracuse, New York 13210

Address all correspondence and requests for reprints to: Arnold M. Moses, M.D., Institute for Human Performance, Room 1264, University Hospital, 750 East Adams Street, Syracuse, New York 13210. E-mail: mosesa{at}upstate.edu.

Abstract

We report a case of central diabetes insipidus (CDI) in a patient with AIDS due to cytomegalovirus (CMV) infection of the vasopressin-producing areas of the hypothalamus. The clinical diagnosis is established by definitive clinical and laboratory evidence of CDI. Detailed histopathological and immunohistochemical studies establish CMV as the causative agent and demonstrate the deficit of vasopressin in the synthesizing neurons. Physicians caring for patients with AIDS should be aware of CDI and adipsic hypernatremia as potential complications of CMV infection. The case also demonstrates that patients with diabetes insipidus do not have polyuria when glucocorticoid deficiency coexists.

Footnotes

Abbreviations: AVP, Vasopressin; CDI, central diabetes insipidus; CMV, cytomegalovirus; MR, magnetic resonance.