A case report of small bowel perforation secondary to cytomegalovirus related immune reconstitution inflammatory syndrome in an AIDS patient

Gutiérrez-Delgado, Eva María; Villanueva-Lozano, Hiram; Rojas-Acosta, Miguel J. García; Miranda-Maldonado, Ivett; Ramos‐Jiménez, Javier

doi:10.1016/j.amsu.2016.11.001

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…Herpesviruses, including HSV as well as CMV, VZV, and KSV, are well-recognized causes of IRIS [10–13]. Clinical manifestations of IRIS associated with herpesviruses can include flares of CMV retinitis or enterocolitis [14–16], varicella zoster [11], or unmasking or paradoxical worsening of Kaposi’s sarcoma [17]. The new appearance or increased frequency of herpetic genital ulcers are among the most common syndromes reported during immune reconstitution [18–22]; most of these are caused by HSV-2.…”

Section: Introductionmentioning

confidence: 99%

Increase in HSV shedding at initiation of antiretroviral therapy and decrease in shedding over time on antiretroviral therapy in HIV and HSV-2 infected persons

Ford

Magaret

Cedric

et al. 2018

Aids

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Objectives: HIV-infected persons with chronic herpesvirus infections may experience paradoxical worsening after initiation of antiretroviral therapy (ART), but the impact of longer term ART is unclear. We evaluated the relationships between genital herpes simplex virus (HSV) shedding and ART initiation and time on therapy in HIV and HSV-2 infected persons. Design: Prospective observational study. Methods: Rates of HSV shedding in 45 HIV and HSV-2 infected persons on or off ART were prospectively followed over up to three, non-contiguous, 60-day periods, during which participants performed daily genital swabs for HSV detection by real-time HSV DNA PCR and reported symptoms. Initiation or discontinuation of ART was at the discretion of participants’ healthcare providers. Results: 6,425 daily genital swabs were obtained from 45 persons (38 men and 7 women) during 105 swabbing sessions. During the three sessions, 67%, 74%, and 92% of persons were on ART. HSV was detected on 26.5% of days in men and 22.3% of days in women. The overall rates of genital HSV shedding were 19.4% of days in persons not on ART, 30.2% in persons within 90 days of ART initiation, and 23.3% in persons on ART for longer than 90 days. After initiation of ART, HSV shedding decreased by 2% per month, or 23% per year (RR 0.98 /month on ART, p=0.0003 in adjusted analysis). This finding was consistent after including consideration of HIV viral load and CD4 count. Conclusions: HSV shedding increased significantly shortly after ART initiation but decreased with time on prolonged ART.

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Section: Introductionmentioning

confidence: 99%

Increase in HSV shedding at initiation of antiretroviral therapy and decrease in shedding over time on antiretroviral therapy in HIV and HSV-2 infected persons

Ford

Magaret

Cedric

et al. 2018

Aids

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“…CMV infection causes GI ischemia due to submucosal vasculitis and thrombosis. Besides, the thinning of the GI wall may promote subsequent perforation and gangrene [7]. The diagnosis is made by histopathological analysis, but the gold standard for diagnosis is the discovery of cytomegalic cells using H&E. Cytomegalic cells have cow eye inclusions with a surrounding halo [10].…”

Section: Discussionmentioning

confidence: 99%

Gastric Perforation in a 60-Year-Old Woman with CMV Gastritis and Amphetamine Abuse Led to Death

Khajeh

Safari

Seyyedi

et al. 2022

Case Rep Gastroenterol

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Gastric perforation as a multi-etiological disease is a full-thickness injury of the stomach wall. In this case report, we presented a 60-year-old woman with a history of suicidal behavior referred to the emergency unit with a decreased level of consciousness due to the multidrug consumption (amphetamine and benzodiazepine). Passing 3 days of admission in the intensive care unit, the patient represented severe abdominal distension, lack of defecation, and the absence of bowel sound, which suggested the gastrointestinal (GI) complication. Abdominal-pelvic sonography followed by laparotomy confirmed the gastric perforation, which finally led to the patient’s death. Pathological analysis showed that the vast involvement of cytomegalovirus (CMV) in the patient’s GI tract resulted in several peptic ulcers. The first report of gastric perforation-related death arises from the partnership of CMV infection and drug poisoning.

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“…The multiple small bowel perforations in this case were associated with CMV related immune reconstitution in ammatory syndrome (IRIS). Up to now, only ve IRIS-associated cases including our case were reported [1][2][3][4] (summarized in Table 1). Most cases lacked prodromal symptom of diarrhea.…”

Section: Discussionmentioning

confidence: 99%

The Presentation of Multiple Perforations in the Small Bowel as Cytomegalovirus Related Immune Reconstitution Inflammatory Syndrome in an HIV-infected Patient: a Case Report

Wang¹,

Lin²,

Li³

et al. 2021

Preprint

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Background: Multiple perforations in the small bowel as cytomegalovirus (CMV) related immune reconstitution inflammatory syndrome (IRIS) in an human immunodeficiency virus (HIV)-infected patient is very rare. Up to now, only five IRIS-associated cases including our case were reported. We performed pathological examination, metagenomic next-generation sequencing (mNGS), CMV and immune cells immunohistochemical staining for rapid diagnosis and differential diagnosis.Case presentation: We describe a case with multiple perforations in the small bowel as CMV related IRIS in an HIV-infected patient. The patient appeared multiple perforations in the small bowel after 26 days of antiretroviral therapy (ART). The patient underwent exploratory laparotomy. Partial resection and surgical repair of small intestine were performed. CMV enteritis was confirmed by immunohistochemistry staining and other opportunistic infections were excluded by mNGS. However, he died from intestinal obstruction and septic shock at 55 days after surgery. Conclusions: Perforations due to CMV related IRIS are very rare, and usually lack the prodromal period symptoms of abdominal pain and diarrhea. It is not easily foreseen and appears shortly after ART. The condition of intestinal perforations is lethal, and early identification and surgical treatment are lifesaving.

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A case report of small bowel perforation secondary to cytomegalovirus related immune reconstitution inflammatory syndrome in an AIDS patient

Cited by 9 publications

References 17 publications

Increase in HSV shedding at initiation of antiretroviral therapy and decrease in shedding over time on antiretroviral therapy in HIV and HSV-2 infected persons

Increase in HSV shedding at initiation of antiretroviral therapy and decrease in shedding over time on antiretroviral therapy in HIV and HSV-2 infected persons

Gastric Perforation in a 60-Year-Old Woman with CMV Gastritis and Amphetamine Abuse Led to Death

The Presentation of Multiple Perforations in the Small Bowel as Cytomegalovirus Related Immune Reconstitution Inflammatory Syndrome in an HIV-infected Patient: a Case Report

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