The clinical spectrum of cytomegalovirus colitis in adults

Einbinder, Yael; Wolf, Dana; Pappo, Orit; Migdal, A; Tsvang, Eduard; Ackerman, Zvi

doi:10.1111/j.1365-2036.2008.03595.x

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…Common endoscopic findings include isolated or multiple ulcers, erosions, and mucosal hemorrhage, although mucosal sloughing, pseudopolyps, pseudomembranes, and even mass lesions in the colon have been observed [8, 9]. Histology is often considered the “gold standard” for diagnosing end-organ disease.…”

Section: Discussionmentioning

confidence: 99%

Debilitating Chronic Diarrhea Caused by Generalized Gastrointestinal Cytomegalovirus Infection in an Immunocompetent Adult

Telakis¹,

Tsironi

Παπαθεοδώρου

et al. 2014

Case Reports in Gastrointestinal Medicine

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Gastrointestinal cytomegalovirus (CMV) infection is a common opportunistic infection in immunocompromised patients, especially patients with acquired immunodeficiency syndrome and transplant recipients. In contrast, CMV infection of the gastrointestinal tract is rare in immunocompetent individuals. We report a case of severe, protracted, and debilitating diarrhea caused by generalized CMV infection of the gastrointestinal tract in an elderly woman with no apparent immunosuppression. An extensive diagnostic investigation demonstrated CMV-associated disease affecting both the upper and lower gastrointestinal tracts (esophagus, small intestine, and colon). Such extensive simultaneous involvement of the alimentary tract in an immunocompetent patient is rare and presents a diagnostic and therapeutic challenge. The diagnosis was based on a combination of endoscopic, histopathological, serological, and polymerase chain reaction analysis findings and our patient was successfully treated with intravenous ganciclovir. Our case demonstrates that gastrointestinal CMV infection should be considered in the differential diagnosis of severe chronic diarrhea in immunocompetent patients and that antiviral treatment may be justified in this setting.

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Section: Discussionmentioning

confidence: 99%

Debilitating Chronic Diarrhea Caused by Generalized Gastrointestinal Cytomegalovirus Infection in an Immunocompetent Adult

Telakis¹,

Tsironi

Παπαθεοδώρου

et al. 2014

Case Reports in Gastrointestinal Medicine

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“…CMV colitis is relatively rare among immunocompetent patients [Rafailidis et al, 2008], and complication by toxic megacolon has not been reported. Toxic megacolon, however, is common among immunocompromised patients in whom it is usually caused by reactivation of a latent CMV infection [Einbinder et al, 2008].…”

Section: Discussionmentioning

confidence: 99%

Recurrent cytomegalovirus colitis with megacolon in an immunocompetent elderly man

Lin

Yeh

Chen

et al. 2010

Journal of Medical Virology

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Gastrointestinal infection with cytomegalovirus (CMV) is uncommon in immunocompetent hosts. The case of a 70-year-old male with CMV colitis, who has no history of chronic inflammatory bowel disease or immunodeficiency is described. Diagnosis was aided by the identification of inclusion bodies that reacted positively for CMV by immunohistochemical testing in biopsy specimens from the colonic mucosa. His hospital course was characterized by poor improvement of his symptoms after the CMV infection was treated with ganciclovir, and the occurrence of megacolon. A repeat colonoscopy with biopsy revealed a recurrence of the CMV infection. Although CMV colitis is common in immunocompromised patients, we believe this is the first case of CMV colitis with megacolon and recurrent CMV infection in an immunocompetent patient. Colitis caused by CMV colitis should be considered in elderly people with diarrhea.

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“…Dies war häufiger im Rahmen der Erstinfektion als bei der Reaktivierung zu beobachten [11,14]. Symptome reichen hierbei von blutigen Diarrhöen oder dem Nachweis von okkultem Blut im Stuhl [12], abdominellen Schmerzen und Fieber bis akuten oder chronischen Diarrhöen [13,28]. Auch in unserem geschilderten Fall fand sich eine typische klinische Symptomatik mit Bauchschmerzen und (blutigen) Diarrhöen.…”

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“…Als Goldstandard gilt weiterhin der typische histopathologische Befund mit "Eulenaugen-Zellen". Die Sensitivität der HE-gefärbten Histopathologie variiert allerdings stark und liegt teilweise nur bei etwa 20 % [28,33,40]. Sie lässt sich jedoch durch zusätzliche immunhistochemische Methoden auf bis zu 80 % deutlich erhöhen [33,39,40].…”

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“…Das Spektrum makroskopischer endoskopischer Veränderungen ist dabei unspezifisch und weit. Das Bild reicht von entzündlichen Schleimhautveränderungen mit Erythem, Mikroerosionen über ein diffuses Schleimhautödem, multiplen Erosionen bis hin zur Ulzeration oder Pseudomembranbildung [28,41,42]. Ein typisches makroskopisches Bild existiert in der Endoskopie aus diesem Grund nicht.…”

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CMV-assoziierte Enterokolitis im Rahmen einer primären CMV-Infektion im Immunkompetenten

et al. 2013

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Cytomegalovirus (CMV) plays an important role in non-immunocompetent patients due to its high seroprevalence and life-long persistence. However, cases of severe CMV infections are also described in the immunocompetent. Here in particular, the gastrointestinal involvement is of major importance. We describe the case of a 29-year-old immunocompetent young man, who presented with a primary CMV infection mainly of the colon with clinical signs of bloody diarrhoea, fever, hepatitis and haemolysis. The diagnosis was established on the basis of a suspicious endoscopic finding with immunohistochemical detection of CMV in the colonic mucosa, a positive CMV viral load in the peripheral blood and an immune system response typical for primary infection. Based on this case and previous publications, we suggest that a colonoscopy and diagnostic procedures for CMV should be considered if the patient presents with gastrointestinal symptoms like (bloody) diarrhoea, fever, and hepatitis. In a severe case, we recommend antiviral therapy due to a high mortality that has been reported for CMV colitis in immunocompetent individuals.

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The clinical spectrum of cytomegalovirus colitis in adults

Abstract: SUMMARY BackgroundColonic cytomegalovirus reactivation rarely occurs in adults without inflammatory bowel disease or a known immunosuppressive state.

Cited by 14 publications

References 34 publications

Debilitating Chronic Diarrhea Caused by Generalized Gastrointestinal Cytomegalovirus Infection in an Immunocompetent Adult

Debilitating Chronic Diarrhea Caused by Generalized Gastrointestinal Cytomegalovirus Infection in an Immunocompetent Adult

Recurrent cytomegalovirus colitis with megacolon in an immunocompetent elderly man

CMV-assoziierte Enterokolitis im Rahmen einer primären CMV-Infektion im Immunkompetenten

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