Gastrointestinal Cytomegalovirus Disease

Goodgame, Richard

doi:10.7326/0003-4819-119-9-199311010-00010

Cited by 401 publications

(265 citation statements)

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“…Based on the outcome of our case, when progressive pancytopenia is observed during cyclophosphamide treatment for SLE, a bone marrow aspiration should be performed at an early stage to identify the cause of pancytopenia. The occurrence of CMVdisease in the gastrointestinal tract has been recently noted in immunocompromised hosts (9), such as AIDS patients (10, 1 1), transplant recipients and patients receiving immunosuppressive therapy ( 1 2). In addition, inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease, are frequently complicated by this disease (1 3).…”

Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus Complicated by Cytomegalovirus-Induced Hemophagocytic Syndrome and Colitis.

et al. 2002

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Here, wereport a case of systemic lupus erythematosus (SLE) complicated by cytomegalovirus (CMV)-induced hemophagocytic syndrome (HPS) and colitis. A 44-year-old womanwith SLE was treated with corticosteroid and cyclophosphamide for lupus nephritis. Although her lupus nephritis improved, fever, progressive pancytopenia and intestinal bleeding were observed. A bone marrow aspiration showed an increase in mature histiocytes with hemophagocytosis. In addition, a colonoscopy showed hemorrhagic colitis with ulcer and the biopsy specimen from the colon revealed typical CMVcells with CMVinclusions confirmed by immunohistochemistry. Furthermore, a large number of CMVantigen-positive leukocytes was detected, suggesting an active CMVinfection. CMVinfection is serious in compromised hosts. Therefore clinicians should be aware of the clinical settings in which this infection can arise and the target organs potentially affected in order to initiate the appropriate intervention. (Internal Medicine 41: 151-155, 2002)

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Section: Discussionmentioning

confidence: 99%

Systemic Lupus Erythematosus Complicated by Cytomegalovirus-Induced Hemophagocytic Syndrome and Colitis.

et al. 2002

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“…It was suggested that CMV may cause endothelial disruption, creating a favourable environment for extrapulmonary P carinii infection (15). Alternatively, it has been suggested that CMV can secondarily infect tissue with rapid growth such as endothelial cells in inflammatory tissue (21). If this hypothesis is true, then the situation would be reversed -the presence of CMV would be secondary to the effect of the primary P carinii infection.…”

Section: Discussionmentioning

confidence: 97%

AIDS‐Related Extrapulmonary Pneumocystis carinii Infection Presenting as a Solitary Rectal Ulcer

Yoshida

Filipenko

Phillips

et al. 1996

Canadian Journal of Gastroenterology and Hepatology

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Since the widespread adoption of prophylaxis against Pneumocystis carinii, the incidence of infection as an indicator disease for acquired immunodeficiency syndrome (AIDS) has declined from 53% in 1989 to 16% in 1993 (1). Despite this, P carinii still remains a significant problem in human immunodeficiency virus (HIV)-infected patients and P carinii pneumonia (PCP) remains the leading diagnostic indicator for the new diagnosis of AIDS in the United States (1). Extrapulmonary infection with P carinii, although uncommon, has been more frequently reported in the past few years (2-17). Aerosolized pentamidine has been considered a contributing factor in the development of extrapulmonary P carinii infection in many of these reports (5-17). As aerosolized pentamidine achieves high pulmonary concentrations with minimal systemic absorption (18), it is hypothesized that pulmonary infection is suppressed without the benefit of EM YOSHIDA, D FILIPENKO, P PHILLIPS, JSG MONTANER, JS WHITTAKER. AIDS-related extrapulmonary Pneumocystis carinii infection presenting as a solitary rectal ulcer. Can J Gastroenterol 1996;10(6):401-404. Extrapulmonary infection with Pneumocystis carinii, although uncommon, is increasingly recognized. Use of aerosolized pentamidine versus a systemic medication is thought to be a contributing factor due to the low concentrations of drug that are incapable of suppressing systemic infection. Infection with P carinii has been reported in every organ system including the gastrointestinal system. A 28-year-old acquired immunodeficiency syndrome patient receiving prophylaxis with aerosolized pentamidine who presented with a solitary rectal ulcer is reported. Initial biopsy was characteristic of extrapulmonary P carinii infection, with numerous organisms present. Occasional cytomegalovirus inclusion bodies were noted which may have been a copathogen but which were not treated. Treatment with intravenous pentamidine resulted in documented eradication of P carinii and complete resolution of the ulcer. Although lower gastrointestinal pneumocystosis has been described without ulceration, this is the first description of rectal ulceration presenting as the initial manifestation of extrapulmonary pneumocystosis. Key Words: Acquired immunodeficiency syndrome, Extrapulmonary Pneumocystis carinii, Rectal ulcerInfection extra-pulmonaire à Pneumocystis carinii liée au SIDA sous la forme d'un ulcère rectal solitaire RÉSUMÉ : L'infection extra-pulmonaire à Pneumocystis carinii, bien que rare, est de plus en plus observée. L'utilisation de la pentamidine en aérosol versus un médicament systémique pourrait être un facteur contributif à cause des faibles concentrations du médicament qui sont incapables de supprimer l'infection systémique. L'infection à P. carinii a été signalée dans tous les organes, y compris dans l'appareil digestif. Nous décrivons ici le cas d'un patient de 28 ans atteint du syndrome de l'immuno-déficience acquise ayant reçu en prophylaxie de la pentamidine en aérosol et qui a présenté un ulcère rectal s...

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“…Megacólon tóxico fatal por cytomegalovirus em paciente com retocolite ulcerativa idiopática: relato de caso e revisão de literatura A análise histopatológica define o diagnóstico, sendo caracterizada por células infectadas com tamanho de 25 a 35 µm de diâmetro, contendo inclusão eosinofílica intranuclear, rodeada por halo claro e cromatina granular, além da possível associação com inclusões citoplasmáticas basofílicas (5) . A utilização de anticorpos monoclonais anti-CMV por meio de técnicas como a imunoperoxidase e imunofluorescência, e a hibridização in situ aumentam a sensibilidade da análise histopatológica.…”

Section: Discussionunclassified

Megacólon tóxico fatal por cytomegalovirus em paciente com retocolite ulcerativa idiopática: relato de caso e revisão de literatura

Ioshii

Teixeira

Figueiredo

2002

Arq. Gastroenterol.

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RESUMO -Racional -O megacólon tóxico é complicação grave e pouco freqüente na retocolite ulcerativa idiopática. Ocorre, geralmente, em pacientes cuja doença ativa é resistente ao tratamento clínico e, em algumas situações, o fator desencadeante é desconhecido. A infecção pelo cytomelogalovirus em seres humanos em geral é evento subclínico; entretanto, em pacientes imunocomprometidos a primoinfecção ou mesmo a reativação de infecção latente pode ter amplas repercussões clínicas, uma das quais o desencadeamento de megacólon tóxico. Objetivo -Descrever um caso de megacólon tóxico fatal por cytomegalovirose em paciente com retocolite ulcerativa idiopática. Paciente -Masculino, 38 anos, com clínica de diarréia e perda ponderal cuja investigação mostrou tratar-se de retocolite ulcerativa idiopática e para a qual foi instituída terapêutica imunossupressora vigorosa. Resultados -Evoluiu com quadro clínico de megacólon tóxico, sendo submetido a colectomia total. Complicações clínicas culminaram no óbito pós-operatório e o estudo anatomopatológico do cólon revelou doença ativa, associada a ulcerações confluentes na base das quais foram observadas células com alterações características da cytomegalovirose. Conclusão -A cytomegalovirose deve ser considerada como um dos agentes causadores de megacólon tóxico em retocolite ulcerativa. Doença inflamatória difusa da mucosa colônica e retal, de causa ainda desconhecida, a retocolite ulcerativa idiopática (RCUI) tem distribuição bimodal com predomínio no sexo masculino. A busca por sua etiologia tem dirigido investigação para a influência de fatores biológicos, genéticos, psicológicos e imunológicos. Manifesta-se com intensidade variável de diarréia sanguinolenta, dor abdominal e desnutrição, sendo a complicação mais temida o megacólon tóxico. Este, cuja patogênese é explicada por muitas teorias, uma das quais é a da destruição do plexo nervoso mioentérico e da muscular própria, manifesta-se clinicamente por íleo paralítico associado a quadro séptico, resultando em taxas elevadas de mortalidade. Tem-se sugerido como desencadeadores do megacólon tóxico o uso de corticosteróides e a cytomegalovirose. A associação de doença gastrointestinal com cytomegalovirus (CMV) é causa comum de emergência cirúrgica abdominal em pacientes imunocomprometidos. DESCRITORES -A infecção por CMV é comum em seres humanos, sendo que a maioria dos casos é subclínica. Aproximadamente 50% a 80% dos indivíduos ao redor dos 35 anos de idade apresentam anticorpos anti-CMV circulantes. A cytomegalovirose é observada em todos os segmentos do trato gastrointestinal (7) . Há evidências de que pacientes com RCUI apresentam com maior freqüência níveis mais elevados de anticorpos anti-CMV que adultos normais (6) . Os relatos de RCUI associada à

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Gastrointestinal Cytomegalovirus Disease

Cited by 401 publications

References 0 publications

Systemic Lupus Erythematosus Complicated by Cytomegalovirus-Induced Hemophagocytic Syndrome and Colitis.

Systemic Lupus Erythematosus Complicated by Cytomegalovirus-Induced Hemophagocytic Syndrome and Colitis.

AIDS‐Related Extrapulmonary Pneumocystis carinii Infection Presenting as a Solitary Rectal Ulcer

Megacólon tóxico fatal por cytomegalovirus em paciente com retocolite ulcerativa idiopática: relato de caso e revisão de literatura

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