An Unusual Presentation of Cytomegalovirus Infection: Generalized Edema

Abstract

Objective: Cytomegalovirus (CMV) infection may rarely lead to protein-losing gastropathy that presents with nausea, vomiting, abdominal pain, and edema in immunocompetent children, but extremely rarely with only generalized edema. Clinical Presentation and Intervention: A previously healthy 5-year-old boy presented with generalized edema without any other symptoms. He had hypoalbuminemia but no proteinuria. He was evaluated for gastrointestinal protein loss, and hypertrophic gastropathy was revealed on esophagogastroduodenoscopy. Meanwhile, CMV infection was detected by serologic tests and polymerase chain reaction in the blood. He recovered spontaneously within a week. Conclusion: CMV-related protein-losing gastropathy may present with generalized edema without any gastrointestinal symptoms.

Clinical Manifestation of Cytomegalovirus-Associated Protein-Losing Enteropathy in Children

“…In our study, the most commonly presenting symptoms of CMV-associated PLE were vomiting followed by generalised oedema associated with unspecific symptoms suggesting a viral illness, similar to the few case reports and short case series depicting this disease in children [12][13][14][23][24][25][26][27]. To characterise all the manifestations of CMV-associated PLE, we considered the immunological status of patients and did not just focus on gastropathy, as is often the case [12][13][14][23][24][25][26]. Digestive symptoms prevailed in immunocompetent patients, and an altered general state was observed in both groups.…”

“…However, CMV-associated PLE is poorly considered. In our study, the most commonly presenting symptoms of CMV-associated PLE were vomiting followed by generalised oedema associated with unspecific symptoms suggesting a viral illness, similar to the few case reports and short case series depicting this disease in children [12][13][14][23][24][25][26][27]. To characterise all the manifestations of CMV-associated PLE, we considered the immunological status of patients and did not just focus on gastropathy, as is often the case [12][13][14][23][24][25][26].…”

“…Thus, early detection is important to avoid severe CMV disease in immunosuppressed patients [ 31 ], and CMV infections are commonly sought in this population. On the other hand, CMV-associated PLE is described as being benign and self-limited in immunocompetent children [ 12 , 13 , 14 , 24 , 26 ]. However, in our study, some immunocompetent children had an altered state, needed emergency care and five of them (23.8%) had a severe course.…”

Measles virus and cytomegalovirus co-infection, in a child with recent SARS-CoV-2 infection, during COVID-19 pandemic: a case report

“…Acquired CMV infection in healthy children is common and can asymptomatically proceed or cause a self limited mononucleosis-like syndrome. Unusual CMV-related manifestations have been also reported, such as protein-losing gastropathy presenting with vomiting, abdominal pain, and generalized edema [ 1 , 5 ]. Measles is a very contagious infection with significant mortality and morbidity in children [ 6 ].…”

“…Acquired cytomegalovirus (CMV) infection is common in infancy and generally asymptomatic in healthy children [ 1 ]. Conversely, despite the immunization programs have significantly reduced the incidence of measles, the serious related complications keep on occurring frequently in children under the age of 5 years [ 2 ].…”