Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

Abstract

BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

Human cytomegalovirus‐related gastrointestinal disease after kidney transplantation: A systematic review

“…The length of treatment is usually guided by continuous clinical evaluations, serial hCMV viral load testing in blood samples, and assessment of hCMV‐specific T‐cell immunity 112 . Only imaging or endoscopy can actually confirm complete recovery, 113 though this approach is not always practical. Secondary prophylaxis with a three‐to‐six‐month course of valganciclovir has been suggested in patients with severe forms of hCMV‐GID, early recurrence after anti‐viral therapy discontinuation, and weak hCMV‐specific T‐cell immunity 7,18,114,115 …”

“…111 The length of treatment is usually guided by continuous clinical evaluations, serial hCMV viral load testing in blood samples, and assessment of hCMV-specific T-cell immunity. 112 Only imaging or endoscopy can actually confirm complete recovery, 113 though this approach is not always practical.…”