Cytomegalovirus Colitis in Primary Hypogammaglobulinemia With Normal CD4+ T Cells: Deficiency of CMV-Specific CD8+ T Cells

Abstract

CMV colitis has been reported in immunocompromized patients with severe deficiency of CD4+ T cells and T cell functions. In this study we present an extensive immunological analysis in a patient with primary hypogammaglobulinemia and CMV colitis who had normal numbers of CD3+T, CD4+T and CD8+T cells, and normal T cell proliferative responses to mitogens and recall antigens. Naïve (TN), central (TCM), and effector (TEM) memory subsets of CD4+ and CD8+ T cells, Granzyme+ and Perforin+ CD8+ T cells, PD-1+ T cells, CD4 Treg, CD8 Treg, and CMV tetramer specific CD8+ T cells were analyzed with specific antibodies and isotype controls using multicolor flow cytometry. CD8 TEM, Granzyme+ and Perforin+, and PD-1 CD8+T cells were increased, whereas CD8 TN and CD8 TCM cells were decreased in the patient as compared to controls. CMV tetramer+ CD8+ T cells were decreased in the patient. These data demonstrate that a deficiency of CMV-specific CD8+ T cells even in the presence of normal CD4+ T cell numbers and normal T cell functions may predispose patients with primary hypogammaglobulinemia to CMV colitis.

Cytomegalovirus in primary immunodeficiency

“…There are 27 published case reports or series detailing 34 total patients presenting with CMV-related complications in the CVID population (see Table 1) [48–71]. These reports describe a wide spectrum of clinical disease including: CMV enterocolitis (25/34, 73.5%), CMV pneumonitis (6/34, 17,6%), CMV retinitis (3/34, 8.8%), symptomatic viraemia (2/34, 5.8%), CMV myelitis (1/34, 2.9%) and asymptomatic viraemia (1/34, 2.9%).…”

A Case of Severe Colitis in an HIV-Positive Patient With CD4 Count >200cells/μL

“…There are data demonstrating that a deficiency of CMV-specific CD8 + T cells, even in the presence of normal CD4 + T-cell count numbers and function, may predispose patients with primary hypogammaglobulinemia to CMV colitis. 5 In our patient, her likely underlying protein losing enteropathy resulted in severe hypogammaglobulinemia which can contribute to reactivation of a latent CMV infection.…”

“…Interactions with drugs and foods have been reported to be influencing factors. 5,6 We report a case of suspected interaction between levodopa and banana in a patient with PD who was taking bananas on a daily basis to improve chronic constipation.…”

Possible Role of Cytomegalovirus in Gastric Cancer Development and Recurrent Macrolide-Resistant Campylobacter jejuni Infection in Common Variable Immunodeficiency: A Case Report and Literature Discussion

“…CMV infection is usually asymptomatic or mild in immunocompetent individuals, leading to lifelong persistent infection with periods of reactivation, and can cause more serious conditions in immunocompromised individuals [ 31 ]. There are few reported cases of CMV gastrointestinal disease [ 32 , 33 ] and viremia in patients with CVID [ 34 , 35 ]. CMV should be considered in the differential diagnosis of patients with CVID and gastrointestinal involvement, emphasizing not only impaired B cell immunity but also impaired T cell immunity.…”