1
|
Bankur MN, Keeling A, Adil Shah KM, Avenoso D. CMV Colitis: A Rare Complication of Azacitidine and Venetoclax Chemotherapy. Hematol Rep 2022; 14:213-221. [PMID: 35893153 PMCID: PMC9326678 DOI: 10.3390/hematolrep14030029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/12/2022] [Accepted: 06/13/2022] [Indexed: 12/18/2022] Open
Abstract
Herein, we present a case of cytomegalovirus (CMV) colitis that occurred after two cycles of azacitidine and venetoclax in a 64-year-old woman affected with acute myeloid leukaemia (AML) secondary to a previous diagnosis of a hypoplastic myelodysplastic syndrome (hypo-MDS). This patient never had detectable CMV viraemia, and there was no evidence of immune deficiency that could justify this opportunistic infection. Additionally, this is most likely the first report describing CMV colitis in a patient treated upfront with azacitidine and venetoclax.
Collapse
Affiliation(s)
- Mustafa Nissar Bankur
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
- Neurosciences Department, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Archie Keeling
- Radiology Department, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | | | - Daniele Avenoso
- Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
- Correspondence:
| |
Collapse
|
2
|
Cytomegalovirus Reactivation After Bendamustine-Based Chemotherapy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Severe Cytomegalovirus Reactivation in Patient with Low-Grade Non-Hodgkin's Lymphoma after Standard Chemotherapy. Case Rep Hematol 2017; 2017:5762525. [PMID: 29201472 PMCID: PMC5671693 DOI: 10.1155/2017/5762525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/29/2017] [Accepted: 10/09/2017] [Indexed: 12/20/2022] Open
Abstract
Clinically significant cytomegalovirus (CMV) reactivation is not uncommon in patients with severe immunodeficiency secondary to underlying medical disorders or following aggressive immunosuppressive therapy. However, it is less frequently found in patients with low-grade haematological malignancies after nonintensive chemotherapy. We treated a patient at our centre for stage IVB follicular lymphoma with standard chemotherapy who successively developed CMV colitis associated with a CMV viral load of >3 million copies/ml. Four lines of antiviral treatment were necessary to obtain biochemical remission with undetectable CMV levels, with an initially insufficient response to valganciclovir despite therapeutic pre- and posttreatment levels. Subsequently, our patient also developed an infection with Pneumocystis jirovecii pneumonia (PJP) as further evidence of severe immune compromise. This case report demonstrates the importance of including investigations for less common sources of infection when confronted with a patient with a low-grade haematological malignancy and a pyrexia of unknown origin.
Collapse
|
4
|
Jain A, Prakash G, Khadwal A, Malhotra P, Bal A, Ahluwalia J, Varma S. Bloody Diarrhea in a Patient of Aggressive Lymphoma: a Diagnostic and Therapeutic Challenge. Indian J Hematol Blood Transfus 2017; 33:423-426. [PMID: 28824250 PMCID: PMC5544639 DOI: 10.1007/s12288-016-0748-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ankur Jain
- Department of Internal Medicine, PGIMER, 4th floor, Nehru Hospital, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Internal Medicine, PGIMER, 4th floor, Nehru Hospital, Chandigarh, 160012 India
| | - Alka Khadwal
- Department of Internal Medicine, PGIMER, 4th floor, Nehru Hospital, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Internal Medicine, PGIMER, 4th floor, Nehru Hospital, Chandigarh, 160012 India
| | - Amanjit Bal
- Department of Histopathology, PGIMER, Chandigarh, 160012 India
| | | | - Subhash Varma
- Department of Internal Medicine, PGIMER, 4th floor, Nehru Hospital, Chandigarh, 160012 India
| |
Collapse
|
5
|
Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer. Eur J Clin Microbiol Infect Dis 2014; 33:1847-53. [DOI: 10.1007/s10096-014-2107-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
|
6
|
Abstract
Cancer patients, particularly those with neutropenia, are at risk for enteric and intra-abdominal infections. Specific infections and infectious syndromes in this setting include neutropenic enterocolitis, bacterial infections such as Clostridium difficile infection (CDI), viral infections such as CMV colitis, and parasitic infections such as strongyloidiasis. Diagnosing and gauging the severity of CDI presents challenges, as chemotherapy may produce symptoms that mimic CDI and laboratory findings such as leukocytosis are not reliable in this population. Treatment for enteric infections should be pathogen specific, although broad-spectrum antibiotics are often required as initial empiric therapy in patients with neutropenia.
Collapse
Affiliation(s)
- Michael Wang
- Division of Infectious Diseases, Lakeland Regional Medical Center, 1234 Napier Avenue, St. Joseph, MI, 49085, USA,
| | | |
Collapse
|
7
|
Cytomegalovirus colitis following azacitidine therapy. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2012; 22:e21-3. [PMID: 22942891 DOI: 10.1155/2011/616725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The present report describes the first recognized case of cytomegalovirus (CMV) colitis following azacitidine therapy. A 66-year-old woman with myelodysplastic syndrome developed CMV colitis, which responded to treatment with ganciclovir. Currently, patients receiving azacitidine do not undergo CMV testing, or receive prophylaxis or CMV-free blood products; however, this policy needs to be revised.
Collapse
|
8
|
Nomura K, Fujimoto Y, Yamashita M, Morimoto Y, Ohshiro M, Sato K, Oyake T, Kowata S, Konishi H, Yoshikawa T, Ishida Y, Taniwaki M. Absence of pseudomembranes in Clostridium difficile-associated diarrhea in patients using immunosuppression agents. Scand J Gastroenterol 2009; 44:74-8. [PMID: 18781540 DOI: 10.1080/00365520802321238] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Clostridium difficile is a major cause of diarrhea in hospitalized patients. Although pseudomembranes are crucial evidence for diagnosis of C. difficile-associated diarrhea (CDAD), some cases do not show any pseudomembranes. The aim of this study was to verify the hypothesis that pseudomembranes are not generated in immunosuppressed patients because of the absence of immunoreactions. MATERIAL AND METHODS We investigated the endoscopic findings of patients with ulcerative colitis (UC) or who had received hematopoietic stem cell transplantation, and who presented with C. difficile toxin A and had undergone colonoscopy between April 2002 and July 2007 at our institutes. Results. In 4 patients the diagnosis was UC and C. difficile infection, and in another 4 patients the diagnosis was CDAD after hematopoietic stem cell transplantation. None of these cases showed pseudomembranes. Shallow ulcers were found in all four cases with UC. Only non-specific findings were obtained for the CDAD patients after hematopoietic stem cell transplantation. CONCLUSIONS Pseudomembranes, the typical evidence for CDAD, were not detected in any patients using immunosuppressive agents. Additional bacterial examination is therefore essential when UC becomes exacerbated and when patients present with diarrhea after hematopoietic stem cell transplantation, even in the absence of pseudomembranes.
Collapse
Affiliation(s)
- Kenichi Nomura
- Department of Molecular Hematology and Oncology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Cytomegalovirus-related neutropenic enterocolitis with negative CMV antigenemia as the initial presentation in an acute myeloid leukemia patient. Ann Hematol 2008; 88:279-80. [DOI: 10.1007/s00277-008-0596-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 08/08/2008] [Indexed: 10/21/2022]
|
10
|
Teraishi F, Shimamura H, Suzuki T, Nakamoto M, Chikuba A, Nezu M, Kohsaka S, Takiue T, Chikuba H. Cytomegalovirus colitis after systemic chemotherapy in a patient with recurrent colon cancer: a case report. J Med Case Rep 2008; 2:289. [PMID: 18755014 PMCID: PMC2542395 DOI: 10.1186/1752-1947-2-289] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 08/28/2008] [Indexed: 11/25/2022] Open
Abstract
Introduction The occurrence of cytomegalovirus colitis is well known in immunosuppressed patients, such as neoplastic patients following chemotherapy, although its exact etiology remains unclear. Case presentation We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer. Initial colonoscopy revealed multiple punched-out ulcers in the transverse colon and the diagnosis of cytomegalovirus was based on positive cytomegalovirus antigen detected by indirect enzyme antibody method, although immunohistological examination of tissues biopsied at colonoscopy was negative. The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually. Conclusion The most probable cause of the cytomegalovirus colitis in this case was impaired immunity following chemotherapy. Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.
Collapse
Affiliation(s)
- Fuminori Teraishi
- Chikuba Hospital for Gastrointestinal and Colorectal Surgery, Kurashiki 710-0142, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Lee June
- General Surgery Department, Changi General Hospital, Singapore, Singapore
| | | | | |
Collapse
|
12
|
Aksoy S, Harputluoglu H, Kilickap S, Dede DS, Dizdar O, Altundag K, Barista I. Rituximab-related viral infections in lymphoma patients. Leuk Lymphoma 2007; 48:1307-12. [PMID: 17613758 DOI: 10.1080/10428190701411441] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recently, a human/mouse chimeric monoclonal antibody, rituximab, has been successfully used to treat cases of B-cell non-Hodgkin's lymphoma and some autoimmune diseases. However, several viral infections related to rituximab have been reported in the literature, but were not well characterized. To further investigate this topic, relevant English language studies were identified through Medline. There were 64 previously reported cases of serious viral infection after rituximab treatment. The median age of the cases was 61 years (range: 21 - 79). The median time period from the start of rituximab treatment to viral infection diagnosis was 5.0 months (range: 1 - 20). The most frequently experienced viral infections were hepatitis B virus (HBV) (39.1%, n = 25), cytomegalovirus infection (CMV) (23.4%, n = 15), varicella-zoster virus (VZV) (9.4%, n = 6), and others (28.1%, n = 18). Of the patients with HBV infections, 13 (52.0%) died due to hepatic failure. Among the 39 cases that had viral infections other than HBV, 13 died due to these specific infections. In this study, about 50% of the rituximab-related HBV infections resulted in death, whereas this was the case in only 33% of the cases with other infections. Close monitoring for viral infection, particularly HBV and CMV, in patients treated with rituximab should be recommended.
Collapse
Affiliation(s)
- Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|