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Kothari K, Patil M, Malipatel R, Devarbhavi H. Lessons of the month: Massive gastrointestinal bleeding in a young woman with idiopathic thrombocytopenic purpura (ITP). Clin Med (Lond) 2021; 21:e100-e102. [PMID: 33479087 DOI: 10.7861/clinmed.2020-0803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cytomegalovirus (CMV) is a ubiquitous pathogen, belongs to the herpes virus family and can infect the gastrointestinal (GI) system. The disease is usually noted in immunocompromised patients such as solid organ transplant recipients on immunosuppressive drugs, patients with malignancy receiving chemotherapy, patients with AIDS, patients on steroids for autoimmune disorders, and is rarely seen in immunocompetent individuals. In the GI system, CMV most commonly involves the colon, followed by oesophagus, stomach and, rarely, the small intestine. The GI manifestation of CMV infection is usually anorexia, diarrhoea, and blood in stools, abdominal pain and fever. Very rarely, CMV infection may present with a massive GI bleed. We report a case of 36-year-old pregnant woman with idiopathic thrombocytopenic purpura (ITP) who presented with massive GI bleeding following delivery, attributed to isolated CMV enteritis.
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Panarelli NC, Yantiss RK. Inflammatory and infectious manifestations of immunodeficiency in the gastrointestinal tract. Mod Pathol 2018; 31:844-861. [PMID: 29403083 DOI: 10.1038/s41379-018-0015-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/24/2017] [Accepted: 12/11/2017] [Indexed: 12/27/2022]
Abstract
Immune compromise may result from genetic abnormalities, HIV/AIDS, or consequences of therapy for neoplastic and autoimmune diseases. Many immunocompromised patients develop severe gastrointestinal symptoms, particularly diarrhea, accompanied by non-specific or mild endoscopic abnormalities; mucosal biopsy with pathologic interpretation has a major role in the diagnosis and management of these patients. Immunocompromised individuals are at risk for all the diseases that affect those with a healthy immune system, but they are also prone to other illnesses that rarely affect immunocompetent patients. This review discusses the gastrointestinal manifestations of primary and acquired immunodeficiency, chemotherapy-related injury, and infections that show a predilection for immunocompromised patients. Key histologic features and relevant differential diagnoses are emphasized.
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Shen L, Youssef D, Abu-Abed S, Malhotra SK, Atkinson K, Vikis E, Melich G, MacKenzie S. Cytomegalovirus duodenitis associated with life-threatening duodenal hemorrhage in an immunocompetent patient: A case report. Int J Surg Case Rep 2017; 33:102-106. [PMID: 28292662 PMCID: PMC5348597 DOI: 10.1016/j.ijscr.2017.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 02/18/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cytomegalovirus (CMV) is known to be opportunistic in immunocompromised patients. However, there have been emerging cases of severe CMV infections found in immunocompetent patients. Gastrointestinal (GI) CMV disease is the most common manifestation affecting immunocompetent patients, with duodenal involvement being exceedingly rare. Presented is a case of an immunocompetent patient with life-threatening bleeding caused by CMV duodenitis, requiring surgical intervention. PRESENTATION OF CASE A 60-year-old male with history of disseminated Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia and aortic valve infective endocarditis, presented with life-threatening upper GI hemorrhage. Endoscopy revealed ulcerations, with associated generalized mucosal bleeding in the duodenum. After repeated endoscopic therapies and failed interventional-radiology arterial embolization, the patient required a duodenectomy and associated total pancreatectomy, to control the duodenal hemorrhage. Pathologic review of the surgical specimen demonstrated CMV duodenitis. Systemic ganciclovir was utilized postoperatively. DISCUSSION GI CMV infections should be on the differential diagnosis of immunocompetent patients presenting with uncontrollable GI bleeding, especially in critically ill patients due to transiently suppressed immunity. Endoscopic and histopathological examinations are often required for diagnosis. Ganciclovir is first-line treatment. Surgical intervention may be considered if there is recurrent bleeding and CMV duodenitis is suspected because of high potential for bleeding-associated mortality. CONCLUSION Presented is a rare case of life-threatening GI hemorrhage caused by CMV duodenitis in an immunocompetent patient. The patient failed endoscopic and interventional-radiology treatment options, and ultimately stabilized after surgical intervention.
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Affiliation(s)
- Lucy Shen
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada.
| | - David Youssef
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Suzan Abu-Abed
- Department of Pathology, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Sangita K Malhotra
- Department of Infectious Diseases, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Kenneth Atkinson
- Department of Gastroenterology, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Elena Vikis
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - George Melich
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
| | - Shawn MacKenzie
- Department of General Surgery, Royal Columbian Hospital, University of British Columbia, New Westminster, BC, Canada
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Liao SC, Ko CW, Yeh HZ, Chang CS. Severe diarrhea caused by cytomegalovirus in an elderly man. ADVANCES IN DIGESTIVE MEDICINE 2015. [DOI: 10.1016/j.aidm.2015.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Magalhães-Costa P, Bispo M, Chagas C. Cytomegalovirus enterocolitis in a patient with common variable immunodeficiency: A capsule endoscopy-aided diagnosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 39:336-8. [PMID: 26027514 DOI: 10.1016/j.gastrohep.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/18/2015] [Accepted: 04/08/2015] [Indexed: 01/11/2023]
Affiliation(s)
- Pedro Magalhães-Costa
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal.
| | - Miguel Bispo
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
| | - Cristina Chagas
- Gastroenterology Department, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
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7
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Koc B, Bircan HY, Altaner S, Cinar O, Ozcelik U, Yavuz A, Kemik O. Massive Alimentary Tract Bleeding due to Cytomegalovirus Infection in an Elderly Patient. Infect Dis Rep 2014; 6:5512. [PMID: 25276331 PMCID: PMC4178269 DOI: 10.4081/idr.2014.5512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 01/17/2023] Open
Abstract
In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.
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Affiliation(s)
- Bora Koc
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Huseyin Yuce Bircan
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Semsi Altaner
- Department of Pathology, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Ozlem Cinar
- Department of Anesthesia, Intensive Care Unit, Faculty of Medicine, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Umit Ozcelik
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yuzuncu Yil University, Van, Turkey
| | - Ozgur Kemik
- Department of General Surgery, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
- Yuzuncu Yil University Medical Faculty, Department of Surgery, Kampus, Ercis Yolu, Van, Turkey. +90.505.5566969 - +90.432.4251024.
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Papadimitriou G, Koukoulaki M, Vardas K, Florou E, Argyrakos T, Lakiotis G, Apostolou T, Drakopoulos S. Small bowel obstruction caused by inflammatory cytomegalovirus tumor in a renal transplant recipient: report of a rare case and review of the literature. Transpl Infect Dis 2012; 14:E111-5. [DOI: 10.1111/j.1399-3062.2012.00784.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 05/09/2012] [Accepted: 05/27/2012] [Indexed: 02/04/2023]
Affiliation(s)
- G. Papadimitriou
- First Department of Surgery and Transplant Unit; Evangelismos General Hospital; Athens; Greece
| | - M. Koukoulaki
- First Department of Surgery and Transplant Unit; Evangelismos General Hospital; Athens; Greece
| | - K. Vardas
- First Department of Surgery and Transplant Unit; Evangelismos General Hospital; Athens; Greece
| | - E. Florou
- First Department of Surgery and Transplant Unit; Evangelismos General Hospital; Athens; Greece
| | - T. Argyrakos
- Department of Pathological Anatomy; Evangelismos General Hospital; Athens; Greece
| | - G. Lakiotis
- Second Department of Surgery; Evangelismos General Hospital; Athens; Greece
| | - T. Apostolou
- Department of Nephrology; Evangelismos General Hospital; Athens; Greece
| | - S. Drakopoulos
- First Department of Surgery and Transplant Unit; Evangelismos General Hospital; Athens; Greece
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CMV enteritis causing massive intestinal hemorrhage in an elderly patient. Case Rep Med 2010; 2010. [PMID: 20706684 PMCID: PMC2913790 DOI: 10.1155/2010/385795] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Accepted: 06/15/2010] [Indexed: 12/16/2022] Open
Abstract
Background. Cytomegalovirus (CMV) disease is rare in previously immunocompetent patients. We report a case of CMV enteritis complicated by massive intestinal bleeding. Case History. A 72-year-old immunocompetent patient was admitted for diarrhea and abdominal pain. Aspecific pattern of duodenitis was found at abdomen computed tomography and on biopsies during endoscopy. A diagnosis of vasculitis was suspected on the basis of the clinical and biological course (skin lesions, arthralgias, proteinuria, low complement C3 and C4 fractions, etc.) and pulse steroid therapy was prescribed. The patient developed multiple episodes of intestinal bleeding with shock and required urgent laparotomy. Jejunitis due to CMV vasculitis was proven by histological examination of the operative specimen. Treatment with ganciclovir was initiated. No bleeding recurrence was noted. No other lesions from CMV infection were observed. The patient died from unrelated complications. Discussion. CMV enteritis is a rare cause of intestinal bleeding particularly in previously immunocompetent patients. Aging could be accompanied by a relative immune weakness and specific antiviral therapy seems to be indicated.
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Abstract
Gastrointestinal (GI) infections are a major cause of morbidity and mortality worldwide. Although infectious organisms are often recovered by microbiological methods, surgical pathologists play an invaluable role in diagnosis. The lower GI tract, including the appendix, large bowel, and anus, harbors a wide variety of pathogens. Some infections are part of disseminated disease, whereas others produce clinicopathologic scenarios that are specific to the lower GI tract. This review focuses on selected infectious disorders of the lower GI tract that may be encountered by the general surgical pathologist, including viral, bacterial, fungal, and parasitic organisms, and including infections caused by food- and water-borne pathogens. Diagnostic gross and histologic features are discussed, as well as useful clinical features and ancillary diagnostic techniques. Pertinent differential diagnoses are also emphasized, including other inflammatory conditions of the gut (such as ischemia or idiopathic inflammatory bowel disease) that can be mimicked by lower GI infections.
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Affiliation(s)
- Laura W Lamps
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Shorey 4S/09, Little Rock, AR 72205, USA.
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Lauwers G, Mino-Kenudson M, Kradin RL. Infections of the Gastrointestinal Tract. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2010. [PMCID: PMC7152102 DOI: 10.1016/b978-1-4160-3429-2.00009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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June L, Chin N, Chatterjee D. Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient. Indian J Surg 2008; 70:28-31. [PMID: 23133012 DOI: 10.1007/s12262-008-0006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 01/28/2008] [Indexed: 12/25/2022] Open
Abstract
Cytomegalovirus infection is ubiquitous but often remains asymptomatic in affected patients. Symptomatic cytomegalovirus infection usually occurs in immunocompromised patients- patients who are infected with the Human Immunodeficiency Virus, have received organ transplantations, or are on immunosuppressive therapies. Cytomegalovirus colitis can present with abdominal pain, diarrhea and significant per rectal blood loss. It is a rare entity in immunocompetent patients and can often be missed unless one has a high index of suspicion. We describe a case of CMV colitis in a 78-year-old patient with no known risk factors for immunosuppression who was admitted for respiratory diseases and then subsequently developed transfusion dependent lower gastrointestinal bleeding. She ultimately required surgical resection of her colon. A literature review on CMV colitis, its myriad manifestations and therapeutic outcomes was conducted, with particular emphasis on its occurrence in immunocompetent patients.
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Affiliation(s)
- Lee June
- General Surgery Department, Changi General Hospital, Singapore, Singapore
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13
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Abstract
Cytomegalovirus enteritis is most usually associated with patients positive for human immunodeficiency virus or immunosuppressed transplant patients. The gastrointestinal tract may be affected anywhere from the esophagus to the colon, but the small bowel involvement is rare. We report a case of cytomegalovirus ileitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.
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Affiliation(s)
- Kum Hei Ryu
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
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Cocchi S, Di Benedetto F, Codeluppi M, Guaraldi G, Lauro A, Bagni A, Pecorari M, Gennari W, Quintini C, Esposito R, Pinna AD. Fatal cytomegalovirus necrotising enteritis in a small bowel transplantation adult recipient with low pp65 antigenaemia levels. Dig Liver Dis 2006; 38:429-33. [PMID: 16169779 DOI: 10.1016/j.dld.2005.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 07/05/2005] [Accepted: 07/07/2005] [Indexed: 12/11/2022]
Abstract
Although advances in immunosuppressive therapy have led to increased survival of solid organ transplantation recipients, it is well established that current protocols have been associated with an increased risk of developing tissue-invasive infections. In particular, cytomegalovirus still represents an important cause of morbidity. We report a case of cytomegalovirus infection involving the graft ileum with documented necrotising enteritis that developed after small bowel transplantation. The patient, a 56-year-old Caucasian female with a postsurgery short bowel syndrome, underwent a small bowel transplantation. Immunosuppression was maintained by combination of tacrolimus, steroids and daclizumab. Both the donor and the recipient were serologically negative for cytomegalovirus IgG. Nevertheless, ganciclovir prophylaxis was given for 21 days after surgery, as standard procedure. On hospital day 174, routine pp65 antigenaemia resulted positive (14/200,000 peripheral blood leukocytes). The patient was asymptomatic and preemptive ganciclovir therapy was instituted. In the following 3 days, due to a cytomegalovirus antigenaemia increase, ganciclovir was changed to foscarnet with subsequent virological response (7/200,000 peripheral blood leukocytes, on day 181). Two days later, the patient complained of acute abdominal pain and she underwent surgery for the diagnosis. Since the intraoperative findings consisted of a diffuse acute purulent peritonitis, the intestinal graft, together with native rectum, was removed. Biopsy specimens showed evidence of tissue-invasive cytomegalovirus infection. Postsurgery, the patient developed septic shock and died on day 198 as a consequence of multiple organ failure.
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Affiliation(s)
- S Cocchi
- Department of Internal Medicine and Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy.
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15
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Yakoub-Agha I, Maunoury V, Wacrenier A, Couignoux S, Depil S, Desreumaux P, Bauters F, Colombel JF, Jouet JP. Impact of Small Bowel Exploration Using Video-Capsule Endoscopy in the Management of Acute Gastrointestinal Graft-versus-Host Disease. Transplantation 2004; 78:1697-701. [PMID: 15591963 DOI: 10.1097/01.tp.0000141092.08008.96] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of the global diagnostic approach on the outcome of patients suspected of having acute (a) gastrointestinal (GI) graft-versus-host disease (GVHD). METHODS Ten consecutive patients with suspected aGI-GVHD were prospectively explored with an exhaustive approach including video-capsule endoscopy (VCE). Images observed with VCE were compared with results obtained with other GI investigations including duodenal biopsies. RESULTS.: Five patients had a normal VCE examination: four were successfully treated symptomatically, but one died as a result of toxoplasmosis. VCE disclosed aGI-GVHD lesions in all five remaining patients, and two of the five were considered normal by upper GI endoscopy. All of these patients experienced improvement in their GI symptoms within 2 weeks of adjustments to their immunosuppressive treatment. CONCLUSIONS This approach has enhanced the authors' ability to adapt immunosuppressive treatments in patients suffering from suspected aGI-GVHD. Further investigation of the apparently high negative predictive value of VCE will be of great interest, particularly with a view to avoiding unnecessary immunosuppressive treatment.
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Affiliation(s)
- Ibrahim Yakoub-Agha
- Service des Maladies du Sang, UAM d'Allogreffes de Cellule Souches Hématopoïétiques, CHRU de Lille, F-59037 Lille, France.
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Kanda K, Kume K, Yoshikawa I, Watanabe T, Yamasaki T, Hirose A, Otsuki M. Cytomegalovirus esophagitis with massive upper-GI hemorrhage. Gastrointest Endosc 2004; 59:741-3. [PMID: 15114330 DOI: 10.1016/s0016-5107(04)00184-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kikuo Kanda
- Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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Abstract
Persons with HIV infection, leukemia, lymphoma, solid organ and bone marrow transplants, and inherited immune deficiencies as well as those on immunosuppressive drugs are at high risk for infections of the gastrointestinal tract. Pathogenic as well as opportunistic viruses, bacteria, fungi, and protozoa cause infections in the esophagus, stomach, small intestine, and large intestine. Symptoms may be mild but more often are severe and even life threatening. This article reviews what is new in the field of gastrointestinal infections in the immunocompromised host during the past year. I will place specific emphasis on articles that are most pertinent to clinical care.
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Affiliation(s)
- Lori Fantry
- University of Maryland Medical School, Institute of Human Virology, Baltimore, Maryland, USA.
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Cohen Y, Paltiel O, Amir G, Da'as N, Engelhard D, Polliack A. Unusual cytomegalovirus complications after autologous stem cell transplantation for large B cell lymphoma: massive gastrointestinal hemorrhage followed by a communicating hydrocephalus. Bone Marrow Transplant 2002; 29:715-6. [PMID: 12180120 DOI: 10.1038/sj.bmt.1703519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Unusual cytomegalovirus (CMV)-related complications were seen after autologous stem cell transplantation (SCT) in a 50-year-old patient with diffuse large B cell lymphoma. One month after SCT, the patient developed life-threatening upper gastrointestinal tract (GIT) bleeding with several episodes of hemorrhagic shock. Endoscopy and subsequent explorative laparotomy revealed deep-seated bleeding ulcers containing intracellular CMV inclusion bodies distributed extensively in the GIT, from the lower esophagus to the small bowel. Later, she developed gradual loss of consciousness with communicating hydrocephalus which was possibly secondary to CMV-induced ventriculitis. She recovered completely after insertion of a ventriculostomy and subsequent V-P shunt.
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Affiliation(s)
- Y Cohen
- Department of Hematology Hadassah University Hospital, Jerusalem, Israel 91120
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Abstract
Immunocompromised patients, including patients with AIDS, solid organ and bone marrow transplant recipients, patients with leukemia and lymphoma, patients with inherited immune deficiencies, and patients on immunosuppressive therapy for a variety of disorders, are at risk for infections-particularly opportunistic infections, which, by definition, do not infect the healthy host. All systems of the body, including the gastrointestinal tract, are susceptible. The esophagus, stomach, small intestine, and large intestine are sites of infection for viruses, bacteria, fungi, and protozoa. Symptoms can range in severity from fevers of unknown etiology to life-threatening hemorrhage and perforation. This review summarizes recent case reports, clinical studies, and reviews pertaining to pathogens that uniquely cause disease, more frequently cause disease, or cause more severe disease in the immunocompromised host than in the immunocompetent host.
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Affiliation(s)
- Lori Fantry
- Institute of Human Virology, University of Maryland Medical School, Baltimore, Maryland 21201, USA.
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