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

Alukal, Joseph; Asif, Mohammed; Mundada, Rachana; McNamee, William

doi:10.1136/bcr-2017-221121

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…Furthermore, the marked increase in the lymphocyte count may have exacerbated the CMV colitis. CMV colitis rarely manifests as an IRIS; however, it has been reported as an unmasked IRIS in a patient infected with HIV ( 17 - 19 ). The present patient developed hematochezia, which coincided with the exacerbation of PCP.…”

Section: Discussionmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome Associated with <i>Pneumocystis jirovecii</i> Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

et al. 2022

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A 68-year-old woman presenting with rheumatoid arthritis was admitted due to pancytopenia caused by methotrexate. Pneumocystis jirovecii pneumonia was diagnosed based on the abnormal shadows observed on chest computed tomography, the presence of serum β-D-glucan, and positive P. jirovecii-DNA results in a sputum analysis. Subsequently, after treatment with leucovorin and trimethoprim-sulfamethoxazole, lung consolidation was found to be aggravated, along with a rapidly increasing leukocyte count. In addition, cytomegalovirus colitis was diagnosed. Both conditions were associated with immune reconstitution inflammatory syndrome caused by recovery from leukopenia. The patient was successfully treated with intravenous methylprednisolone pulse therapy and ganciclovir.

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Section: Discussionmentioning

confidence: 99%

Immune Reconstitution Inflammatory Syndrome Associated with <i>Pneumocystis jirovecii</i> Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

et al. 2022

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“…Active CMV colitis is normally identified by endoscopic CMV discovery in colonic tissue, histological tests, including hematoxylin and eosin (H&E) and immunohistochemical (IHC) staining, and/or tissue PCR. H&E staining shows the conventional “owl’s eye” feature; the nuclei of cytomegalic cells containing CMV inclusion bodies are surrounded by clear cytoplasm [ 15 - 16 ]. Given our patient's bloody diarrhea with positive CMV and HIV, the gastroenterology team was consulted, and they decided to proceed with colonoscopy and biopsy [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Occurrence of Cytomegalovirus Colitis and Retinitis as the Initial Presentation of Human Immunodeficiency Virus Infection in a Patient With Zero CD4 Count

Munshi¹,

Almarhabi²,

Mujalled³

et al. 2022

Cureus

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Cytomegalovirus (CMV) can be a reason for severe disease in immunocompromised patients, either via the reactivation of latent CMV infection or via the acquisition of primary CMV infection. Clinical syndromes that may be observed are retinitis, colitis, esophagitis, encephalitis, pneumonitis, hepatitis, uveitis, and graft rejection following transplantation. The simultaneous occurrence of CMV colitis and retinitis as the initial presentation of human immunodeficiency virus (HIV) infection is extremely rare. We present a case of a 42year-old male, known to have type 2 diabetes, bronchial asthma, and allergic rhinitis, who presented to the emergency department (ED) with two weeks history of abdominal pain and watery diarrhea four to five times per day sometimes accompanied by small amounts of blood. He also had an on-and-off subjective fever for the last two months prior to presentation, loss of appetite, and weight loss of 13 kg over the last six months. Additionally, he had a history of travel outside Saudi Arabia and unprotected sex. HIV-1 serology (combination antigen/antibody immunoassay) was requested, which came out positive, with a viral load of 323141 copies/mL and decreased CD4+ T lymphocytes (0 cel/μL). CMV polymerase chain reaction (PCR) quantitative was detected and the CMV viral load was 694963 IU/mL. Given the patient's bloody diarrhea with positive CMV and HIV, the gastroenterology team was consulted and they decided to proceed with a colonoscopy and biopsy. The patient was diagnosed with CMV colitis based on the biopsy results. The patient also was found to have CMV retinitis based on ophthalmologic assessment. Multidisciplinary teams, including infectious diseases, gastroenterology, ophthalmology, and pathology, should cooperate to facilitate an accurate and fast diagnosis. Further complications can be prevented by early diagnosis and treatment.

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“…CMV enteritis presenting as perforation in HIVinfected population showed a high mortality due to high postoperative complications including reperforation, bowel obstruction and severe sepsis complicated by multi-organ failure [8]. CMV colitis could be a manifestation of unmasking or paradoxical IRIS [9][10][11]. The pathogenesis of gastrointestinal CMV disease is believed to be submucosal vasculitis with thrombosis resulting in ischemia, ulcers, thinning of the intestinal wall with subsequent perforation and gangrene [12].…”

Section: Discussionmentioning

confidence: 99%

The Presentation of Multiple Perforations in the Small Bowel as Cytomegalovirus Related Immune Reconstitution Inflammatory Syndrome in an HIV-infected Patient: a Case Report

Wang¹,

Lin²,

Li³

et al. 2021

Preprint

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Background: Multiple perforations in the small bowel as cytomegalovirus (CMV) related immune reconstitution inflammatory syndrome (IRIS) in an human immunodeficiency virus (HIV)-infected patient is very rare. Up to now, only five IRIS-associated cases including our case were reported. We performed pathological examination, metagenomic next-generation sequencing (mNGS), CMV and immune cells immunohistochemical staining for rapid diagnosis and differential diagnosis.Case presentation: We describe a case with multiple perforations in the small bowel as CMV related IRIS in an HIV-infected patient. The patient appeared multiple perforations in the small bowel after 26 days of antiretroviral therapy (ART). The patient underwent exploratory laparotomy. Partial resection and surgical repair of small intestine were performed. CMV enteritis was confirmed by immunohistochemistry staining and other opportunistic infections were excluded by mNGS. However, he died from intestinal obstruction and septic shock at 55 days after surgery. Conclusions: Perforations due to CMV related IRIS are very rare, and usually lack the prodromal period symptoms of abdominal pain and diarrhea. It is not easily foreseen and appears shortly after ART. The condition of intestinal perforations is lethal, and early identification and surgical treatment are lifesaving.

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

Cited by 7 publications

References 7 publications

Immune Reconstitution Inflammatory Syndrome Associated with <i>Pneumocystis jirovecii</i> Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

Immune Reconstitution Inflammatory Syndrome Associated with <i>Pneumocystis jirovecii</i> Pneumonia and Cytomegalovirus Colitis in a Patient with Rheumatoid Arthritis

Simultaneous Occurrence of Cytomegalovirus Colitis and Retinitis as the Initial Presentation of Human Immunodeficiency Virus Infection in a Patient With Zero CD4 Count

The Presentation of Multiple Perforations in the Small Bowel as Cytomegalovirus Related Immune Reconstitution Inflammatory Syndrome in an HIV-infected Patient: a Case Report

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