Differential Diagnosis for Giant Cells + Intranuclear Eosinophilic Inclusions

• Single most likely diagnosis:
  • Cytomegalovirus (CMV) infection: This is the most likely diagnosis due to the presence of giant cells and intranuclear eosinophilic inclusions, which are characteristic of CMV infection, particularly in immunocompromised patients.
• Other Likely diagnoses:
  • Herpes Simplex Virus (HSV) infection: Although less common than CMV, HSV can also cause giant cell formation and intranuclear inclusions, making it a plausible diagnosis.
  • Varicella-Zoster Virus (VZV) infection: Similar to HSV, VZV can lead to the formation of giant cells and intranuclear inclusions, especially in individuals with compromised immune systems.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Progressive Multifocal Leukoencephalopathy (PML): Caused by the JC virus, PML is a rare but potentially fatal condition that can present with giant cells and intranuclear inclusions, particularly in the brain tissue of immunocompromised patients.
  • Human Herpesvirus 6 (HHV-6) infection: Although less common, HHV-6 can cause severe illness in immunocompromised individuals and may present with similar cytological findings.
• Rare diagnoses:
  • Human Herpesvirus 8 (HHV-8) infection: Primarily associated with Kaposi's sarcoma, HHV-8 can also cause intranuclear inclusions, but this is less common and typically seen in specific clinical contexts.
  • Adenovirus infection: While adenovirus can cause a range of clinical manifestations, the presence of giant cells and intranuclear eosinophilic inclusions is less typical, making it a rare consideration in this differential diagnosis.