Cytomegalovirus Colitis, Cytomegalovirus Hepatitis and Systemic Cytomegalovirus Infection: Common Features and Differences

Abstract

Cytomegalovirus (CMV) is a ubiquitous human herpes virus, which, after often asymptomatic primary infection, establishes a lifelong latent infection that can periodically be reactivated in both immunocompetent and immunosuppressed carriers. Whereas the diagnostic approach in case of a suspicion of CMV reactivation is well defined, the indication for antiviral therapy can often only be made in the context of an extent of organ involvement, the immune status, and comorbidities of the patient. This article reviews the epidemiology, diagnosis, and therapy of CMV reactivation with a focus on inflammatory bowel diseases and potentially different diagnostic and therapeutic approaches in Asia and the Western world.

Recurrent cytomegalovirus colitis: a rare case of immune reconstitution inflammatory syndrome

“…Treatment includes induction therapy with ganciclovir at a dose of 5 mg/kg every 12 hours for 3–5 days followed by oral valganciclovir for a total of 2–3 weeks 9. Guidelines on duration of therapy is based on clinical improvement and not based on CD4 count.…”

A Systemic and Severe Infection via Cytomegalovirus and Other Herpesviruses in a Young Apparently Immunocompetent Patient: A Case Report

“…However, severe, multi-visceral organ-damage-involving clinical scenario has been occasionally reported [1]. In particular, colitis, hepatitis [2], pancreatitis [3], pneumonia, myocarditis, mediastinitis, or thrombotic complications [4,5] have been described in cytomegalovirus (CMV) reactivation or primary infection in apparently immunocompetent individuals, in a few cases occurring in a scenario of multiple organ damage [6]. An association of human herpes virus 6 (HHV-6) infection with hepatitis [7,8], pneumonia [9], myocarditis or encephalitis [10,11], as well as of Epstein-Barr virus (EBV) and pneumonia [12], encephalitis [13,14], hepatitis has been rarely described [15].…”

Cytomegalovirus Colitis in Immunocompetent Patients

“…Cytomegalovirus (CMV) infections are generally thought to be opportunistic in patients with immunosuppressive diseases like acquired immunodeficiency syndrome (AIDS), underlying malignancies, and organ- or bone marrow-transplantation and patients under treatment with steroids or chemotherapeutics like cisplatin, fluorouracil, leucovorin, epirubicin, vincristine, etoposide, or gefitinib [1]. …”

“…Since then, several cases have been reported in patients with chronic renal insufficiency and hemodialysis, coinfection with bacterial gastrointestinal infections, and food allergy [1-2]. …”