Cytomegalovirus Infection With Multiple Colonic Perforations in a Renal Transplant Recipient

Bartolomeis, Carmine De; Collini, Andrea; Barni, Roberto; Ruggieri, Giuliana; Bernini, Marco; Carmellini, Mario

doi:10.1016/j.transproceed.2005.06.082

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…The perforation in our patient was an acute process with a new onset that might have been linked to certain infectious agents. Acute onset of intestinal perforation caused by CMV ileitis, in an HIV-positive patient [ 15 , 16 ] in renal transplant recipients [ 17 , 18 ] and in patients with immunocompromised status is also reported [ 19 ]. Other cases of infectious perforation, reported mainly in the past and in developing countries, are caused by typhoid fever [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Amorosi

Longo

Sorotos

et al. 2018

Case Reports in Plastic Surgery and Hand Surgery

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Intestinal perforation (IP) is a life-threatening gastroenterological condition requiring urgent surgical care, which may present itself as an uncommon complication following incisional hernia repair surgery, most often because of iatrogenic traumatism occurring during the procedure. However, we report a case where a spontaneous onset can be hypothesised. A 60-years-old patient underwent repair of an abdominal laparocele, through rectus abdominis muscle plasty, 5 years after development of an incisional hernia due to exploratory laparotomy for the treatment of acute appendicitis. Xipho-pubic scar was excised and umbilicus and supra-umbilical hernia sac dissected, a linear median incision was performed along the sub-umbilical linea alba, reaching preperitoneal plane to assess any intestinal loop adherence to the abdominal wall. After limited viscerolysis, abdominal wall defect was corrected by ‘rectus abdominis muscle plasty’ and umbilicus reconstruction by Santanelli technique. Postoperative course was uneventful until Day 29, with sudden onset of epigastric pain, fever and bulge. Sixty cubic centimeter pus was drained percutaneously and cavity was rinsed with a 50% H2O2 and H2O V-V solution until draining clear fluid. Symptoms recurred two days later, while during rinsing presented dyspnoea. X-Ray and CT scan diagnosed IP, and she underwent under emergency an exploratory laparotomy, leading to right hemicolectomy extended to last ileal loops and middle third of the transverse, right monolateral salpingo-ovariectomy and a temporary ileostomy by general surgeon. Twenty-three days later an ileostomy reversal surgery was performed and 8 days after she was discharged. At latest follow-up patient showed fair conditions, complaining abdominal pain and diarrhoea, attributable to the extensive intestinal resection. IP following incisional hernia repair, is reported as uncommon and early postoperative complication. In our case, the previous regular postoperative course with late onset lead us to hypothesise a possible idiopathic etiopathogenesis, because of a strangulation followed by gangrene and abscess formation, which might begin before the incisional hernia repair and unnoticed at the time surgery was performed.

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Section: Discussionmentioning

confidence: 99%

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Amorosi

Longo

Sorotos

et al. 2018

Case Reports in Plastic Surgery and Hand Surgery

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“…Although it has been reported that in CMV gastroenteritis, the CMV-AG positive rate is approximately 20% at onset and that false-negatives results occur frequently[1], the CMV-AG status becomes positive in most cases during the disease course, thus making this test a useful parameter for monitoring the response to treatment[1,8,14,17]. While there have been reports on rare cases in which patients who had CMV gastroenteritis had CMV-AG results that remained negative throughout the disease course after bone marrow transplantation[13,18,19], there have been no such reports associated with solid-organ transplantation; however, there have been some reports in which the CMV-AG test was positive when an intestinal perforation was caused by CMV gastroenteritis[20,21], including a report in which intestinal perforation were caused by CMV gastroenteritis in patients taking immunosuppressants to treat rheumatoid arthritis[2]. Although it has been reported that routine upper gastrointestinal endoscopy during the follow-up for CMV gastroenteritis does not lead to differences in recurrence rates and treatment effects[17], there are also cases such as ours, where the patient suffers from localized CMV infection but does not achieve viremia and remains CMV-AG negative throughout the disease course.…”

Section: Discussionmentioning

confidence: 99%

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

Yokose

Obara

Shinoda

et al. 2019

WJG

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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.

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“…In transplant recipients, CMV disease of the GI tract is defined by the presence of clinical symptoms consistent with upper or lower GI involvement, mucosal lesions on endoscopy, and evidence of CMV infection by culture, histopathology, or viremia (5). Nausea, vomiting, and early satiety often reflect upper GI involvement in SOT recipients, while diarrhea, bleeding, and perforation can accompany CMV small bowel or colon involvement (9, 10, 19–21). Inflammatory pseudotumors and toxic megacolon have also been described (9, 22).…”

Section: Discussionmentioning

confidence: 99%

Unusual presentation of cytomegalovirus enteritis after liver and kidney transplantation

Alhyraba

Grim

Benedetti

et al. 2007

Transplant Infectious Dis

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Cytomegalovirus (CMV) is a cause of significant morbidity and mortality in solid organ transplant recipients. Gastrointestinal (GI) tract infection by CMV in this population can cause symptomatic disease, which typically manifests as fever, abdominal pain, nausea, and bloody diarrhea. Erosive lesions of the GI mucosa are often evident on endoscopic exam. We report an unusual presentation of CMV enteritis in a kidney and liver transplant recipient with the development of acute onset voluminous watery diarrhea in the absence of other typical symptoms and subsequent progression to hypovolemic shock and acute renal failure. This case emphasizes the atypical presentations of common opportunistic infections that may occur in immunosuppressed hosts.

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Cytomegalovirus Infection With Multiple Colonic Perforations in a Renal Transplant Recipient

Cited by 14 publications

References 13 publications

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

Intestinal perforation after surgical treatment for incisional hernia: iatrogenic or idiopathic?

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

Unusual presentation of cytomegalovirus enteritis after liver and kidney transplantation

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