case_images: PMC10034270_01
case_images: Cystoscopic images demonstrate a white mucosal plaque adjacent to the left
  ureteric orifice (a) as well as multiple areas of oedematous bladder
  urothelium with hyperaemia and non-specific changes (b-d).
case_images: 10.1177_17562872231159531-fig1.jpg
case_images: PMC10034270_01_10.1177_17562872231159531-fig1.jpg
case_images: fig1-17562872231159531
case_images: A subsequent rigid cystoscopy demonstrated multiple areas of oedematous and erythematous bladder urothelium with areas of normal mucosa in between (Figure 1).
case_images: Histopathological analysis showing (a) multiple CMV-infected cells with
  amphophilic intracytoplasmic and intranuclear inclusions (H&E: 100x),
  with associated marked mixed inflammatory infiltrate in the background
  lamina propria, (b) CMV-infected cells with enlarged nuclei with ill-defined
  basophilic to amphophilic intranuclear and intracytoplasmic inclusions
  (H&E: 400x) and (c) positive immunohistochemistry in CMV-infected cells
  (H&E: 400x).
case_images: 10.1177_17562872231159531-fig2.jpg
case_images: PMC10034270_01_10.1177_17562872231159531-fig2.jpg
case_images: fig2-17562872231159531
case_images: Histopathological analysis of the bladder biopsy demonstrated multiple urothelial mucosal fragments infiltrated by a prominent mixed inflammatory population comprising neutrophils, lymphocytes, plasma cells and eosinophils and involving most of the fragments (Figure 2). In addition, multiple scattered cells throughout the fragments exhibited a viral cytopathy by way of enlarged nuclei with ill-defined basophilic to amphophilic intranuclear inclusions and paler amphophilic but similar large intracytoplasmic inclusions (Figure 2). These findings were morphologically consistent with a CMV infection and associated subacute cystitis, which was subsequently confirmed with positive CMV immunohistochemical stains (Figure 2).