Herpes virus infection cytology: the presence of large multinucleated cells, with ground glass type of chromatin, marginal condensation of chromatin, as well as large eosinophilic intranuclear inclusions (Cowdry type A) are typical findings of Herpes simplex virus or varicella zoster virus cytopathic effects. The cytomorphology cannot distinguish HSV-1, HSV-2 or varicella zoster viruses. The first picture, with the Cowdry inclusion could easily be confused with a CMV cytopathic effect. The urine also contained numerous leukocytes and some red cells.
Careful examination of the penis of the patient failed to reveal any lesion, but he refused cystoscopy. This is probably a HSV-2 infection of the urinary tract epithelium in an immunocompromised patient. HSV cystitis (hemorrhagic or not) is a rare complication of HSV infection. PCR of the urine for CMV was negative, and positive for HSV.