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Miyaguchi K, Hamada M, Tsuzuki Y, Imaeda H. Gastrointestinal: Cytomegalovirus enteritis with severe hypoalbuminemia in an immunocompetent patient. J Gastroenterol Hepatol 2024. [PMID: 38403787 DOI: 10.1111/jgh.16520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/16/2024] [Accepted: 02/03/2024] [Indexed: 02/27/2024]
Affiliation(s)
- K Miyaguchi
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - M Hamada
- Department of Histopathology, Saitama Medical University, Saitama, Japan
| | - Y Tsuzuki
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
| | - H Imaeda
- Department of Gastroenterology, Saitama Medical University, Saitama, Japan
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Kim S, Yoon KW, Gil E, Yoo K, Choi KJ, Park CM. Emergency gastrointestinal tract operation associated with cytomegalovirus infection. Ann Surg Treat Res 2023; 104:119-125. [PMID: 36816733 PMCID: PMC9929438 DOI: 10.4174/astr.2023.104.2.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 02/10/2023] Open
Abstract
Purpose Cytomegalovirus (CMV) infection is common in immunocompromised patients. Enterocolitis caused by CMV infection can lead to perforation and bleeding of the gastrointestinal (GI) tract, which requires emergency operation. We investigated the demographics and outcomes of patients who underwent emergency operation for CMV infection of the GI tract. Methods This retrospective study was conducted between January 2010 and December 2020. Patients who underwent emergency GI operation and were diagnosed with CMV infection through a pathologic examination of the surgical specimen were included. The diagnosis was confirmed using immunohistochemical staining and evaluated by experienced pathologists. Results A total of 27 patients who underwent operation for CMV infection were included, 18 of whom were male with a median age of 63 years. Twenty-two patients were in an immunocompromised state. Colon (37.0%) and small bowel (37.0%) were the most infected organs. CMV antigenemia testing was performed in 19 patients; 13 of whom showed positive results. The time to diagnose CMV infection from operation and time to start ganciclovir treatment were median of 9 days. The reoperation rate was 22.2% and perforation was the most common cause of reoperation. In-hospital mortality rate was 25.9%. Conclusion CMV infection in the GI tract causes severe effects, such as hemorrhage or perforation, in immunocompromised patients. When these outcomes are observed in immunocompromised patients, suspicion of CMV infection and further evaluation for CMV detection in tissue specimens is required for proper treatment.
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Affiliation(s)
- Seijong Kim
- Division of Colorectal Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Won Yoon
- Division of Critical Care, Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Eunmi Gil
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keesang Yoo
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Jin Choi
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
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Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
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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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Tao EW, Zou TH, Wang YF, Tang JT, Chen YX, Gao QY. Case report of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE): a rare disease may contribute to endoscopy-capsule retention in the small intestine. BMC Gastroenterol 2019; 19:49. [PMID: 30943900 PMCID: PMC6448319 DOI: 10.1186/s12876-019-0962-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 03/17/2019] [Indexed: 02/08/2023] Open
Abstract
Background CMUSE is a rare disease whose diagnosis remains difficult because the lesion is confined to the small bowel. Case presentation Here, we present a case of 43-year-old female patient suffered chronic abdominal pain for 20 years, and finally diagnosed with CMUSE. Capsule endoscopy was performed when general endoscopic investigation failed to find the lesion, but the capsule was stranded in the small intestine. Moreover, capsule retention results in acute intestinal obstruction. Thus, surgery was performed and CMUSE was confirmed. The patient was recovered after partial small intestine resection. Conclusions Capsule retention occurred in nearly 60% of patients with CMUSE. Capsule endoscopy should be avoided when the patient is suspected of CMUSE, especially with severe anemia and radiologic finding in the ileum.
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Affiliation(s)
- En-Wei Tao
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Tian-Hui Zou
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Yong-Feng Wang
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Jie-Ting Tang
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Ying-Xuan Chen
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China
| | - Qin-Yan Gao
- Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Ren-Ji Hospital, Shanghai Jiao-Tong University School of Medicine, 145 Middle Shandong Road, Shanghai, 200001, China.
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Kohoutová D, Bureš J, Tyčová V, Bártová J, Tachecí I, Rejchrt S, Vacek Z, Repák R, Kopáčová M. Severe Cryptogenic Multifocal Ulcerous Stenosing Enteritis. A Report of Three Cases and Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2016; 53:25-9. [DOI: 10.14712/18059694.2016.59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is a rare condition characterised by chronic or relapsing moderate ileous episodes resulting from multiple small intestinal strictures, multiple shallow ulcers of the small bowel and favourable therapeutical effect of glucocorticosteroids. The aim of this paper was to evaluate three cases of CMUSE diagnosed within 10 years at a tertiary gastroenterology centre. Three females (35, 50, 60 years) were presented with colicky pain, repeated moderate ileous episodes and weight loss. Multiple fibrous strictures and ulcers of the small bowel were found. All three patients responded to glucocorticosteroid treatment. Tandem tight jejunal stenoses were dilated endoscopically by means of double balloon enteroscopy. In conclusion, CMUSE should always be considered when chronic moderate ileous episodes and multiple small intestinal strictures and ulcers of uncertain aetiology are found. Double balloon enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenoses, may obviate the need for surgery and prevent excessive small bowel resections.
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Yoganathan KT, Morgan AR, Yoganathan KG. Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary! BMJ Case Rep 2016; 2016:bcr-2015-214196. [PMID: 27440845 DOI: 10.1136/bcr-2015-214196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm(3) He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis.
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Affiliation(s)
| | - Andrew Roger Morgan
- Department of Surgery, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
| | - Kathir G Yoganathan
- Department of GUM/HIV, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
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Bruno MA, Parodi M, Olmedo I, Picón Molina H, Palencia R, Doniquian A. Massive gastrointestinal bleeding in AIDS patients secondary to histoplasma and cytomegalovirus infection. Int J Surg Case Rep 2016; 25:128-31. [PMID: 27372024 PMCID: PMC4930355 DOI: 10.1016/j.ijscr.2016.05.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
Gastrointestinal CMV infection in the small bowel location is extremely rare. Disseminated histoplasmosis typically affects lower GI Tract and rarely small bowel in addition to other organs. The association between Histoplasmosis and Cytomegalovirus as massive gastrointestinal bleeding cause has not been described. If disseminated histoplasmosis affects small bowel, causes intermittent abdominal pain, chronic diarrhoea and malabsorption.
Introduction The Cytomegalovirus (CMV) is a virus that affects the host and remains latent. When cellular immunity is suppressed, the virus is reactivated and can cause an asymptomatic or devastating infection in immunosuppressed patients. On the other hand, Histoplasmosis is typically a respiratory condition. However, in immunosuppressed patients, it may be found in unusual locations, as in the case of an intestinal condition. In some cases, this can be fatal. Small intestine CMV location is extremely rare. Case presentation 40-year-old man with AIDS presenting secondary massive lower gastrointestinal bleeding (MLGB) symptoms and ulcer granulomatous injuries located in the proximal ileum produced by the association of CMV and histoplasmosis. Conclusion Lower gastrointestinal bleeding diagnosis and treatment pose a challenge, considering the intestine extension and difficulties for its exploration. On the other hand, the association between Histoplasmosis and CMV as a massive gastrointestinal bleeding cause has not been described. There is no bibliography on the matter.
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Affiliation(s)
- Marco Antonio Bruno
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
| | - Matías Parodi
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
| | - Ignacio Olmedo
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
| | - Héctor Picón Molina
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
| | - Rafael Palencia
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
| | - Alejandro Doniquian
- General Surgery Service, University Clinic Reina Fabiola, Catholic University of Córdoba, Oncativo 1248 street, Córdoba Capital, Argentina.
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Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2016; 49:829-836. [PMID: 26850320 DOI: 10.1016/j.jmii.2015.12.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/31/2015] [Accepted: 12/14/2015] [Indexed: 12/19/2022]
Abstract
Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents. However, CMV colitis is increasingly recognized in immunocompetent hosts. Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection. Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology. CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis.
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Hosamirudsari H, Shahnavaz H, Mahooti N. Multiple spontaneous perforation of small bowel by Mycobacterium avium complex infection in an AIDS patient. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Although originally described in Staphylococcus aureus, resistance among bacteria has now become a race to determine which classes of bacteria will become more resistant. Availability of antibacterial agents has allowed the development of entirely new diseases caused by nonbacterial pathogens, related largely to fungi that are inherently resistant to antibacterials. This article presents the growing body of knowledge of the herpes family of viruses, and their occurrence and consequences in patients with concomitant surgical disease or critical illness. The focus is on previously immunocompetent patients, as the impact of herpes viruses in immunosuppressed patients has received thorough coverage elsewhere.
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Affiliation(s)
- Christopher A Guidry
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Sara A Mansfield
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Robert G Sawyer
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Charles H Cook
- Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry 2G, Boston, MA 02215, USA.
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Cryptogenic multifocal ulcerous stenosing enteritis: a review of the literature. Gastroenterol Res Pract 2013; 2013:918031. [PMID: 24369459 PMCID: PMC3858008 DOI: 10.1155/2013/918031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 10/21/2013] [Indexed: 02/07/2023] Open
Abstract
Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) is an extremely rare illness characterised by chronic or relapsing subileus status resulting from multiple small intestinal fibrous strictures and multiple shallow ulcers of the small bowel. The etiology is unknown and pathogenesis is not fully understood. Therapy with systemic glucocorticosteroids is the treatment of choice. However, most patients develop corticosteroid dependence. Deep enteroscopy enables precise diagnostic work, possible endoscopic treatment of stenoses; may obviate the need for surgery and prevent excessive small bowel resections.
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Michalopoulos N, Triantafillopoulou K, Beretouli E, Laskou S, Papavramidis TS, Pliakos I, Hytiroglou P, Papavramidis ST. Small bowel perforation due to CMV enteritis infection in an HIV-positive patient. BMC Res Notes 2013; 6:45. [PMID: 23379792 PMCID: PMC3568738 DOI: 10.1186/1756-0500-6-45] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/28/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cytomegalovirus infection of the gastrointestinal tract is common and is more often seen in patients with acquired immunodeficiency syndrome (AIDS). Although small bowel infection is less common than infection of other parts of the gastrointestinal system, it may lead to perforation, an acute complication, with dreadful results. CASE PRESENTATION This article reports a case of Cytomegalovirus ileitis with multiple small bowel perforations in a young man with human immunodeficiency virus (HIV) infection. The patient developed abdominal pain with diarrhea and fever, and eventually acute abdomen with pneumoperitoneum. The patient had poor prognosis and deceased despite the prompt surgical intervention and the antiviral therapy he received. At pathology a remarkable finding was the presence of viral inclusions in smooth muscle fibers. The destruction of muscle cells was the main cause of perforation. CONCLUSION Morbidity and mortality associated with perforation from CMV enteritis in AIDS patients are high and the life expectancy is short. Cytomegalovirus disease is multifocal; therefore, excision of one portion of the gastrointestinal tract may be followed by a complication elsewhere. Our case elucidate that muscle cell destruction by the virus is a significant cause leading to perforation.
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Affiliation(s)
- Nick Michalopoulos
- Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Gaduputi V, Patel H, Vootla V, Khan U, Chilimuri S. Foscarnet-resistant cytomegalovirus esophagitis with stricturing. Case Rep Gastroenterol 2013; 7:25-9. [PMID: 23466529 PMCID: PMC3573790 DOI: 10.1159/000342352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report the case of a 52-year-old man with HIV-AIDS, non-complaint with highly active antiretroviral therapy, who presented with long-standing dysphagia. He was treated for three episodes of severe Candida esophagitis with fluconazole and later caspofungin due to poor response. In spite of the prolonged treatment courses the patient did not report an improvement in his symptoms. He was also concomitantly being treated for other opportunistic infections including cytomegalovirus (CMV) retinitis with i.v. foscarnet for almost 2 months prior to the index presentation. Upper esophagogastroduodenoscopy revealed multiple superficial ulcers with stricturing. Bougie dilatation was attempted but failed. The biopsy specimens revealed multiple intracellular inclusion bodies pathognomonic of CMV infection. We aim to highlight the increasing resistance of CMV to conventional first-line antiviral agents such as foscarnet.
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Affiliation(s)
- Vinaya Gaduputi
- Department of Medicine, Bronx Lebanon Hospital Center, Bronx, N.Y., USA
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Chiba M, Tsuda H, Sugawara T, Ono I. Medical cure for life-threatening severe cytomegalovirus enteritis in a 71-year-old man. Clin J Gastroenterol 2012; 5:210-5. [PMID: 26182323 DOI: 10.1007/s12328-012-0305-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/04/2012] [Indexed: 11/28/2022]
Abstract
The small bowel is the least common site of involvement in the gastrointestinal tract for cytomegalovirus (CMV) infection. CMV enteritis results in a high rate of emergency surgery for bleeding, perforation, or ileus and a high mortality rate. We report on successful medical treatment for a case of life-threatening severe CMV enteritis. A 71-year-old man, not known to be immunocompromised, suffered diarrhea and periumbilical abdominal pain. Diarrhea persisted and hypoalbuminemia developed, which required total parenteral nutrition. Colonoscopy revealed erosions and redness in the terminal ileum. Esophagogastroduodenoscopy revealed diffuse edema in the duodenum. Enteroclysis showed a narrow and shortened small bowel with an extremely short transit time of the small bowel of <1 min. CMV antigenemia was found on the blood sample. The biopsy specimens from both the duodenum and terminal ileum showed cell infiltration with dominance of eosinophils indicating eosinophilic enteritis. Therefore, ganciclovir 500 mg/day and prednisolone 40 mg/day were started. The diarrhea gradually improved, and a semi-vegetarian diet was started; thereafter, the patient fully recovered. Inclusion bodies were not found in routine hematoxylin-eosin stained sections of the duodenal or ileal specimens. However, a re-evaluation by immunohistochemistry using a monoclonal antibody against CMV revealed positive cells for CMV in both specimens.
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Affiliation(s)
- Mitsuro Chiba
- Division of Gastroenterology, Nakadori General Hospital, 3-15 Misono-cho, Minami-dori, Akita, 010-8577, Japan.
| | - Hidehiko Tsuda
- Division of Gastroenterology, Nakadori General Hospital, 3-15 Misono-cho, Minami-dori, Akita, 010-8577, Japan
| | - Takeshi Sugawara
- Division of Gastroenterology, Nakadori General Hospital, 3-15 Misono-cho, Minami-dori, Akita, 010-8577, Japan
| | - Iwao Ono
- Department of Pathology, Nakadori General Hospital, Akita, Japan
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Shah SK, Kreiner LA, Walker PA, Klein KL, Bajwa KS, Robinson EK, Millas SG, Souchon EA, Wray CJ. Cytomegalovirus enteritis manifesting as recurrent bowel obstruction and jejunal perforation in patient with acquired immunodeficiency syndrome: rare report of survival and review of the literature. Surg Infect (Larchmt) 2012; 13:121-4. [PMID: 22439782 DOI: 10.1089/sur.2010.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) enteritis presenting with perforation in the setting of acquired immunodeficiency syndrome (AIDS) represents a particularly deadly combination. METHODS Case report and review of the pertinent literature. CASE REPORT The authors report a patient with AIDS and CMV enteritis presenting as recurrent small-bowel obstruction and leading to perforation of the jejunum with subsequent survival. CONCLUSION This is believed to represent the second case in the English-language literature of survival after CMV-induced small intestinal perforation in a patient with AIDS.
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Affiliation(s)
- Shinil K Shah
- Department of Surgery, The University of Texas Medical School at Houston, Houston, Texas, USA.
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Navaneethan U, Venkatesh PGK, Wang J. Cytomegalovirus ileitis in a patient after liver transplantation-differentiating from de novo IBD. J Crohns Colitis 2011; 5:354-9. [PMID: 21683307 DOI: 10.1016/j.crohns.2011.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 02/08/2023]
Abstract
Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract has been reported in immunocompromised patients and is seen following liver transplantation. Although CMV infection can affect any part of the GI tract, involvement of the terminal ileum is rarely encountered after liver transplantation. We report a case of a 32-year-old male who developed CMV infection of the terminal ileum while receiving immunosuppression for liver transplantation. Initial ganciclovir treatment did not improve the patient's symptoms and therapy was then switched to foscarnet which ultimately resulted in resolution of infection. However the patient continued to have symptoms because of intermittent small bowel obstruction because of ulcerations and fibrosis ultimately requiring surgical resection. CMV DNA polymerase chain reaction (PCR) was negative throughout the course of infection. Surgical resected specimen revealed no evidence of inflammatory bowel disease (IBD). Follow up colonoscopy up to a year after infection also did not reveal any evidence of IBD. Compartmentalization in the clinical presentation of CMV involving GI tract can be seen with a negative blood DNA PCR. Histological diagnosis thus forms an important part in the clinical follow-up of liver transplant patients undergoing intense immunosuppression and should be aggressively pursued in patients with GI symptoms. De novo IBD should be considered in the differential diagnosis in these patients who do not improve with anti-viral treatment.
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Histologic features of cytomegalovirus enteritis in small bowel allografts. Transplant Proc 2011; 42:2671-5. [PMID: 20832567 DOI: 10.1016/j.transproceed.2010.04.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 04/21/2010] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is one of the most common viral infections to affect solid organ transplant patients, most frequently owing to reactivation of a latent infection as a result of immunosuppression. CMV enteritis (CE) may enter into the differential diagnosis of acute rejection in biopsies of small bowel (SB) allografts, where differentiation is important due to disparate therapies. OBJECTIVE The aim of this study was to identify histologic features in SB allografts that may suggest CE. METHODS The case files for a single institution were queried for all cases of SB mucosal biopsies with cells positive by CMV immunoperoxidase staining. Morphologic and clinical information was reviewed. RESULTS Six biopsies demonstrating immunoperoxidase-confirmed CE were identified in a retrospective review of the records of a single institution. A common predisposing factor was the administration of high-dose steroids within a month before CE diagnosis. Most cases (66%) displayed a demarcated area of villous/crypt loss with an abundance of plasma cells and lymphocytes and a paucity of eosinophils. One case showed an acute enteritis-like pattern of injury, corresponding with a higher number of CMV-positive cells. CMV inclusions were visible on hematoxylin-eosin stains in all but 1 case. In no case were histologic criteria for acute cellular rejection met. CONCLUSIONS The presence of circumscribed area of mucosal injury with few eosinophils or an acute enteritis pattern should prompt the identification of viral inclusions or the acquisition of a CMV immunostain.
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Cytomegalovirus enterocolitis in apparently immunocompetent hosts: evaluation of the radiologic findings and clinical features. J Comput Assist Tomogr 2011; 34:892-8. [PMID: 21084906 DOI: 10.1097/rct.0b013e3181ecc471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To describe the clinical and radiologic features of cytomegalovirus (CMV) enterocolitis in apparently immunocompetent hosts. MATERIALS AND METHODS Our institutional review board approved this retrospective study, and informed consent was waived. Twelve apparently immunocompetent patients (7 women and 5 men; mean age, 58 years) with pathologically proven CMV enterocolitis were included. Computed tomographic (CT) scans were retrospectively reviewed to determine the extent and the location of mural thickening, maximal mural thickness, enhancement pattern, that is, single-halo, double-halo, and homogeneous patterns, and ascites. RESULTS Eight patients had comorbidities potentially affecting the host immune status, whereas 4 patients were apparently healthy before presentation. On CT, all patients showed mural thickening (range, 4-11 mm) involving the colon (n = 8), the small bowel (n = 1), or both (n = 3). Segmental involvement was most common (n = 9 for colon and n = 2 for small bowel), whereas focal involvement of the rectum (n = 1) and diffuse involvement of the entire ileum (n = 1) or the entire small bowel and colon (n = 1) were also noted. Colonic lesions showed variable enhancement patterns, including the single-halo (n = 6), homogeneous (n = 3), and double-halo patterns (n = 2), whereas all small-bowel lesions in 4 patients exhibited a single-ring pattern. Ascites was present in 7 patients. Complications requiring surgery occurred in 3 patients and included refractory bleeding (n = 2) and bowel perforation (n = 1). CONCLUSIONS Cytomegalovirus enterocolitis in immunocompetent hosts typically develops in elderly subjects with comorbidities, although it may also affect relatively young and healthy subjects. On CT, it is characterized by mild mural thickening of the small bowel and the colon and frequently shows segmental involvement and a single-halo enhancement pattern.
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Abstract
Ileitis, or inflammation of the ileum, is often caused by Crohn's disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. The clinical presentation of ileitis may vary from an acute and self-limited form of right lower quadrant pain and/or diarrhea, as in the majority of cases of bacterial ileitis, but some conditions (ie, vasculitis or Mycobacterium tuberculosis) follow a chronic and debilitating course complicated by obstructive symptoms, hemorrhage, and/or extraintestinal manifestations. Ileitis associated with spondylarthropathy or nonsteroidal anti-inflammatory drugs is typically subclinical and often escapes detection unless further testing is warranted by symptoms. In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum. Distinguishing between the various forms of ileitis remains a test of clinical acumen. The diagnosis of the specific etiology is suggested by a detailed history and physical examination, laboratory testing, and ileocolonoscopy and/or radiologic data.
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Affiliation(s)
- Steven Dilauro
- Scripps Clinic Torrey Pines, Division of Gastroenterology, La Jolla, CA 92037, USA
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22
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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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23
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Lin YH, Yeh CJ, Chen YJ, Chang MC, Su IH, Cheng HT. Recurrent cytomegalovirus colitis with megacolon in an immunocompetent elderly man. J Med Virol 2010; 82:638-41. [PMID: 20166177 DOI: 10.1002/jmv.21712] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Gastrointestinal infection with cytomegalovirus (CMV) is uncommon in immunocompetent hosts. The case of a 70-year-old male with CMV colitis, who has no history of chronic inflammatory bowel disease or immunodeficiency is described. Diagnosis was aided by the identification of inclusion bodies that reacted positively for CMV by immunohistochemical testing in biopsy specimens from the colonic mucosa. His hospital course was characterized by poor improvement of his symptoms after the CMV infection was treated with ganciclovir, and the occurrence of megacolon. A repeat colonoscopy with biopsy revealed a recurrence of the CMV infection. Although CMV colitis is common in immunocompromised patients, we believe this is the first case of CMV colitis with megacolon and recurrent CMV infection in an immunocompetent patient. Colitis caused by CMV colitis should be considered in elderly people with diarrhea.
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Affiliation(s)
- Yi-Hsuan Lin
- Division of Digestive Therapeutic Endoscopy, Department of Gastroenterology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
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Cha JM, Lee JI, Choe JW, Joo KR, Jung SW, Shin HP, Choi SI. Cytomegalovirus enteritis causing ileal perforation in an elderly immunocompetent individual. Yonsei Med J 2010; 51:279-83. [PMID: 20191024 PMCID: PMC2824877 DOI: 10.3349/ymj.2010.51.2.279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 07/01/2008] [Accepted: 07/01/2008] [Indexed: 01/21/2023] Open
Abstract
Cytomegalovirus (CMV) infection is usually subclinical in immunocompetent individuals, however it can be life threatening in an elderly immunocompetent individual. We report a case of CMV enteritis causing ileal perforation in a physically active elderly man. An 88-year-old healthy man presented with abdominal pain and diarrhea. After initial conservative treatment, emergency laparotomy was performed for ileal perforation. The diagnosis of CMV enteritis was based on histological findings revealing many large cells with CMV inclusion bodies in the surgical specimen. In elderly individuals, even though they are immunocompetent, CMV enteritis may result in major complications such as bowel perforation, and it should be included in the differential diagnosis of diarrhea if it is resistant to conventional treatment.
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Affiliation(s)
- Jae Myung Cha
- Department of Internal Medicine, East-West Neo Medical Center, Kyung Hee University College of Medicine, Seoul, Korea.
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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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Khan FN, Prasad V, Klein MD. Cytomegalovirus enteritis mimicking Crohn’s disease in a lupus nephritis patient: A case report. World J Gastroenterol 2009; 15:4327-30. [PMID: 19750578 PMCID: PMC2744191 DOI: 10.3748/wjg.15.4327] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract has been reported in both immunocompetent and, more frequently, in immunocompromised patients. We describe a case of a 19-year-old male who developed CMV infection of the terminal ileum while receiving immunosuppression for lupus nephritis. This was a distinctly unusual site of infection which clinically mimicked Crohn’s ileitis. We note that reports of terminal ileal CMV infection have been infrequent. Despite a complicated hospital course, ganciclovir therapy was effective in resolving his symptoms and normalizing his ileal mucosa. This report highlights the importance of accurate histological diagnosis and clinical follow-up of lupus patients with GI symptoms undergoing intense immunosuppression.
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Baroco AL, Oldfield EC. Gastrointestinal cytomegalovirus disease in the immunocompromised patient. Curr Gastroenterol Rep 2008; 10:409-16. [PMID: 18627655 DOI: 10.1007/s11894-008-0077-9] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cytomegalovirus (CMV) has emerged as a significant opportunistic pathogen in the era of immunosuppression. CMV was a common cause of gastrointestinal disease in AIDS patients, but the introduction of highly active antiretroviral therapy has led to a dramatic decline in AIDS-related disease. Among patients with solid organ transplants, CMV has become an increasingly important cause of gastrointestinal disease as more routine use of early CMV prophylaxis has increased delayed-onset disease, which is often tissue invasive at presentation. The role of CMV in inflammatory bowel disease is controversial; treatment may be indicated in selected cases of steroid-refractory disease with evidence of CMV. Diagnosis of gastrointestinal CMV disease generally requires endoscopic biopsy with histologic confirmation. CMV culture of biopsy material may be falsely positive because of contamination from latently infected cells. The standard induction treatment of gastrointestinal CMV disease uses intravenous ganciclovir, though the use of oral valganciclovir is increasing, especially for long-term maintenance or suppression therapy.
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Affiliation(s)
- Allison L Baroco
- Eastern Virginia Medical School, Department of Internal Medicine, Division of Infectious Diseases, 825 Fairfax Avenue, Suite 410, Norfolk, VA 23507, USA.
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Vogel T, Vadonis R, Kühn J, Eing BR, Shenninger N, Haier J. Viral reactivation is not related to septic complications after major surgical resections. APMIS 2008; 116:292-301. [PMID: 18397464 DOI: 10.1111/j.1600-0463.2008.00447.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t-tests and Chi2-tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications.
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Affiliation(s)
- T Vogel
- Molecular Biology Laboratory, Department of General Surgery, University Hospital Münster, Germany
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29
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Arana de la Torre M, Calle Baraja M, Oleagoitia Cilaurre JM, Ulacia Beristain MA. [Megalovirus-induced ileal perforation in a renal transplant patient]. Cir Esp 2008; 83:269-70. [PMID: 18448033 DOI: 10.1016/s0009-739x(08)70568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to perforation or impending gastrointestinal perforation. Gastrointestinal perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
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Affiliation(s)
- John T Langell
- Department of Surgery, University of Utah, 30 North 1900 East, SOM 3B115, Salt Lake City, UT 84132, USA.
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31
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Khan FY, Morad NA. Cytomegalovirus enteritis in a mechanically ventilated patient with chronic obstructive pulmonary disease. Indian J Crit Care Med 2006. [DOI: 10.4103/0972-5229.24689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Nihashi T, Ito K, Kato T, Kato R, Okuda M, Arima T, Bundo M, Kawatsu S, Hayasaka K, Ishigaki T. An abnormal accumulation of fluorine-18-FDG PET in cytomegalovirus enteritis—A case report. Ann Nucl Med 2006; 20:75-8. [PMID: 16485579 DOI: 10.1007/bf02985595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The source of a fever of unknown origin (FUO) and watery diarrhea in a 63-yr-old female with a history of disturbance of consciousness due to moyamoya disease was examined. Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), colonoscopy, blood analysis, and determination of cytomegalovirus (CMV) antigenemia were performed. FDG was found to be accumulated in the wall of a dilated colon, and extended from the transverse to sigmoid colon. Colonoscopy revealed edematous, inflammatory, and punched out lesions in accordance with the areas of abnormal FDG uptake. A biopsy specimen showed the antibody of CMV in the colonic mucosa, and CMV antigenemia was detected by an immunohistochemical assay using a monoclonal antibody for CMV pp65 antigen. From these findings, we strongly suspected CMV enteritis.
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Affiliation(s)
- Takashi Nihashi
- Department of Radiology, National Center for Geriatrics and Gerontology, Ohbu, Japan.
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Vialle R, Burdy G, Drain O, Bernier M, Frileux P. L’entérocolite à cytomégalovirus : Une cause rare d’ischémie et d’hémorragie digestive. ACTA ACUST UNITED AC 2005; 29:1057-9. [PMID: 16435517 DOI: 10.1016/s0399-8320(05)88192-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cytomegalovirus (CMV) infections are frequent in patients with severe immunodeficiency. We report a case of isolated digestive localization in a young woman initially non-immunocompromised. Initially, she was admitted in the intensive-care unit for a severe post-operative shock secondary to a respiratory distress syndrome. She then developed severe enterocolitis which was initially unexplained. Outcome was favorable but digestive perforations required multiple surgical digestive resections. The histological diagnosis was confirmed by immunofluorescence staining and the antigenemia and specific antibodies kinetics. We emphasize the various characteristics of this pathology and point out the risk of missing this unusual cause of digestive perforation and severe bleeding.
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Affiliation(s)
- Raphaël Vialle
- Service de Chirurgie Générale et Digestive, Hôpital Foch, Suresnes
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Petrogiannopoulos CL, Kalogeropoulos SG, Dandakis DC, Hartzoulakis GA, Karahalios GN, Flevaris CP, Zacharof AK. Cytomegalovirus enteritis in an immunocompetent host. Chemotherapy 2004; 50:276-8. [PMID: 15608442 DOI: 10.1159/000082625] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2003] [Accepted: 07/15/2004] [Indexed: 12/13/2022]
Abstract
A 60-year-old healthy woman presented with fever, abdominal pain and bloody diarrhea. After initial conservative therapy, enterectomy was performed because of perforation of the jejunum. Histological analysis and high titer of anti-CMV IgM confirmed the diagnosis. A 2-year follow-up was uneventful. CMV enterocolitis is frequent in immunocompromised patients, but rare in immunocompetent subjects.
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Van Schaeybroeck S, Hiele M, Miserez M, Croes R. Ileal perforation caused by cytomegalovirus infection in an immunocompetent adult. Acta Clin Belg 2002; 57:154-7. [PMID: 12212357 DOI: 10.1179/acb.2002.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A 71-year-old woman developed a small bowel perforation due to cytomegalovirus infection. She did not taken any immunosuppressive medication and her cellular immunity was normal. Surgical resection and antiviral therapy with ganciclovir led to complete recovery. As far as we know, this paper reports the first case of small bowel perforation due to cytomegalovirus infection in a non-immunocompromised patient. Nevertheless the patient was known with diabetes mellitus. It should be emphasised that elderly patients have impaired immune defences and may be unsuspected hosts of opportunistic infections.
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Affiliation(s)
- S Van Schaeybroeck
- Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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