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Jagdale N, Kondapalli MP, Reddy VKK, Adapa S, Sabharwal D. An Unusual Case of an Immunocompetent Adult Diagnosed With Cytomegalovirus Colitis. Cureus 2024; 16:e58595. [PMID: 38765379 PMCID: PMC11102762 DOI: 10.7759/cureus.58595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Cytomegalovirus (CMV) infections are typically considered opportunistic in individuals with immunosuppressive conditions such as human immunodeficiency virus/acquired immunodeficiency syndrome, underlying malignancies, organ or bone marrow transplantation, and those receiving chemotherapeutics or steroids. Nevertheless, there is a significant increase in reported instances of CMV infections globally, suggesting that even individuals with a healthy immune system might experience these infections. In such cases, the primary symptoms are typically related to the gastrointestinal system, such as ulcerative colitis, pseudopolyps, tumors, and ischemic and hemorrhagic enterocolitis. We present a unique instance of severe CMV colitis in a patient with a fully functioning immune system. The diagnosis of CMV colitis was determined through the histological analysis of biopsy tissues acquired during colonoscopy.
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Affiliation(s)
- Nilesh Jagdale
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Mohith Prakash Kondapalli
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Vutukuru Kalyan Kumar Reddy
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Saimounika Adapa
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Diksha Sabharwal
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Hashmi SA, Arora S, Danish Khan I, Varghese J, Pandey R. A Rare Case of Cytomegalovirus Colitis with Subsequent Non-tubercular Mycobacteria Immune Reconstitution Inflammatory Syndrome. Middle East J Dig Dis 2023; 15:63-65. [PMID: 37547156 PMCID: PMC10404077 DOI: 10.34172/mejdd.2023.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 09/01/2022] [Indexed: 08/08/2023] Open
Abstract
Cytomegalovirus (CMV) colitis occurs commonly in immunocompromised patients with high mortality. CMV infection has also been reported in immunocompetent individuals and it has a varied clinical presentation. When HIV-infected patients are started on antiretroviral therapy (ART) there is a reconstitution of the immune system which results in the paradoxical worsening of existing conditions or development of new disease conditions known as immune reconstitution inflammatory syndrome (IRIS). In the setting of IRIS one of the most common infections to occur is non-tubercular mycobacteria (NTM). The infection generally develops when the CD4 count is < 50 cells/µL. Here we present a rare case of CMV colitis followed by NTM infection in the setting of IRIS, its management, and treatment outcomes.
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Affiliation(s)
- Syed Asif Hashmi
- Army College of Medical Sciences and Base Hospital, Delhi Cantt, New Delhi 110010
| | - Sumit Arora
- Army College of Medical Sciences and Base Hospital, Delhi Cantt, New Delhi 110010
| | - Inam Danish Khan
- Army College of Medical Sciences and Base Hospital, Delhi Cantt, New Delhi 110010
| | - Jeenu Varghese
- Army College of Medical Sciences and Base Hospital, Delhi Cantt, New Delhi 110010
| | - Rahul Pandey
- Armed Forces Medical College, Pune, Maharashtra, India
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Harano Y, Kotajima L, Arioka H. Case of cytomegalovirus colitis in an immunocompetent patient: a rare cause of abdominal pain and diarrhea in the elderly. Int J Gen Med 2015; 8:97-100. [PMID: 25767404 PMCID: PMC4354615 DOI: 10.2147/ijgm.s63771] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients after undergoing organ transplantation or chemotherapy. We report the case of a 60-year-old immunocompetent Japanese woman who presented with abdominal pain and bloody diarrhea. She was initially diagnosed as having ischemic colitis with pseudomembranous colitis on the basis of her symptoms, Clostridium difficile antigen positivity, and colonoscopic findings, which showed ulcer formation from the sigmoid colon to rectum. In spite of bowel rest and administration of metronidazole, her symptoms did not improve. On follow-up colonoscopy, ulcerations remained unchanged. Biopsy of the ulceration revealed CMV-infected cells leading to a diagnosis of CMV colitis. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients. We recommend endoscopic biopsy in a case of refractory abdominal pain and bloody diarrhea.
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Affiliation(s)
- Yumi Harano
- Department of General Internal Medicine, St Luke's International Medical Center, Tokyo, Japan
| | - Lisa Kotajima
- Department of General Internal Medicine, St Luke's International Medical Center, Tokyo, Japan
| | - Hiroko Arioka
- Department of General Internal Medicine, St Luke's International Medical Center, Tokyo, Japan
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Koc B, Bircan HY, Altaner S, Cinar O, Ozcelik U, Yavuz A, Kemik O. Massive Alimentary Tract Bleeding due to Cytomegalovirus Infection in an Elderly Patient. Infect Dis Rep 2014; 6:5512. [PMID: 25276331 PMCID: PMC4178269 DOI: 10.4081/idr.2014.5512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 01/17/2023] Open
Abstract
In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.
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Affiliation(s)
- Bora Koc
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Huseyin Yuce Bircan
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Semsi Altaner
- Department of Pathology, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Ozlem Cinar
- Department of Anesthesia, Intensive Care Unit, Faculty of Medicine, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Umit Ozcelik
- Department of Surgery, Baskent University, Istanbul Research Hospital, Van, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yuzuncu Yil University, Van, Turkey
| | - Ozgur Kemik
- Department of General Surgery, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
- Yuzuncu Yil University Medical Faculty, Department of Surgery, Kampus, Ercis Yolu, Van, Turkey. +90.505.5566969 - +90.432.4251024.
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Siciliano RF, Castelli JB, Randi BA, Vieira RD, Strabelli TMV. Cytomegalovirus colitis in immunocompetent critically ill patients. Int J Infect Dis 2014; 20:71-3. [PMID: 24406737 DOI: 10.1016/j.ijid.2013.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Cytomegalovirus (CMV) is a ubiquitous virus and its reactivation may lead to CMV end-organ disease (CMV EOD) in immunocompromised patients and also in immunocompetent patients when they are critically ill. We aimed to investigate the frequency and the clinical features of proven CMV EOD in previously non-immunosuppressed patients admitted to our institution. METHODS From January 2000 to March 2013, the records of all patients with a histopathological diagnosis of CMV EOD at our teaching hospital were reviewed retrospectively. CMV EOD was diagnosed histologically by the identification of true cytomegalic viral inclusion involving endothelial, stromal, and/or epithelial cells on hematoxylin and eosin staining, and was subsequently confirmed by immunohistochemistry using specific antibody against CMV antigens. Immunocompromised patients were excluded. RESULTS CMV EOD manifesting as colitis was diagnosed in 14 previously immunocompetent intensive care unit (ICU) patients. The mean age of the patients was 64 years. All had co-morbidities and developed shock before CMV EOD. The major manifestation was gastrointestinal bleeding. The in-hospital mortality rate was 71.4% despite specific treatment with ganciclovir. CONCLUSIONS Despite being a rare condition, lower gastrointestinal bleeding in this profile of ICU patients could be the clinical manifestation of CMV colitis, and intensivists should be alert to this condition.
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Affiliation(s)
- Rinaldo F Siciliano
- Infection Control Unit, Heart Institute (InCor), University of São Paulo Medical School, Dr. Eneas Carvalho de Aguiar avenue, 255, Cerqueira César, São Paulo 05403-000, Brazil
| | - Jussara B Castelli
- Laboratory of Pathology, Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Bruno A Randi
- Division of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Brazil.
| | - Ricardo D Vieira
- Clinical Cardiology Unit, Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Tânia M V Strabelli
- Infection Control Unit, Heart Institute (InCor), University of São Paulo Medical School, Dr. Eneas Carvalho de Aguiar avenue, 255, Cerqueira César, São Paulo 05403-000, Brazil
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A physiological approach to modernize the management of cancer chemotherapy-induced gastrointestinal toxicity. Curr Opin Support Palliat Care 2010; 4:19-25. [PMID: 20009760 DOI: 10.1097/spc.0b013e32833575cc] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Gastrointestinal toxicity during chemotherapy is frequent. Symptomatic therapies for gastrointestinal toxicity, which do not address the underlying cause, may result in inadequate symptom control. With advances in curative treatment regimens, it becomes more important to minimize treatment toxicity which otherwise may compromise optimal chemotherapy and the chance of cure. RECENT FINDINGS For decades, oncologists have concentrated on delineating the pathological processes, which occur within the gastrointestinal tract during chemotherapy treatment. However, pathological change does not in itself cause symptoms. Symptoms only arise when physiological functions are altered. In immunosuppressed patients, it is a priority to exclude infection as a cause for symptoms. In the presence of diarrhoea, the best investigative paradigm for this is stool culture, upper gastrointestinal endoscopy with duodenal biopsies and duodenal aspirate combined with flexible sigmoidoscopy and left colonic biopsies. Once infection has been excluded, although large studies have not been performed, case series repeatedly suggest that gastrointestinal symptoms arising during cancer chemotherapy can often be cured if newly acquired, gastrointestinal physiological deficits are identified. SUMMARY Although many physiological changes induced by chemotherapy may be relatively transient and settle weeks or months after the end of treatment, during chemotherapy, their manifestations can be protean and severe. A systematic failure to research the frequency with which physiological causes of the symptoms are amenable to treatment has denied many patients' logical therapies for their chemotherapy-induced symptoms, and as a result, it is likely that symptomatic treatments are frequently suboptimal.
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Helgason KO, Raby SJM, Kamel HMH, Laurenson IE, Templeton K, Walsh TS. Cytomegalovirus colitis in a critically ill patient following elective repair of an abdominal aortic aneurysm. Anaesth Intensive Care 2008; 36:107-9. [PMID: 18326142 DOI: 10.1177/0310057x0803600119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a case of cytomegalovirus colitis in a critically ill but otherwise immunocompetent 61-year-old male. Infection was demonstrated by histology and confirmed by plasma polymerase chain reaction and detection of cytomegalovirus IgM antibody. The patient was treated with ganciclovir with resolution of the cytomegalovirus viraemia. Cytomegalovirus colitis may be an under-recognised problem in immunocompetent patients who are critically ill. Quantification of plasma cytomegalovirus DNA by polymerase chain reaction is a non-invasive method of supporting the diagnosis and can be used to monitor the treatment of cytomegalovirus infection in the immunocompetent.
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Affiliation(s)
- K O Helgason
- Critical Care Unit, Edinburgh Royal Infirmary, Edinburgh, United Kingdom
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June L, Chin N, Chatterjee D. Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient. Indian J Surg 2008; 70:28-31. [PMID: 23133012 DOI: 10.1007/s12262-008-0006-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 01/28/2008] [Indexed: 12/25/2022] Open
Abstract
Cytomegalovirus infection is ubiquitous but often remains asymptomatic in affected patients. Symptomatic cytomegalovirus infection usually occurs in immunocompromised patients- patients who are infected with the Human Immunodeficiency Virus, have received organ transplantations, or are on immunosuppressive therapies. Cytomegalovirus colitis can present with abdominal pain, diarrhea and significant per rectal blood loss. It is a rare entity in immunocompetent patients and can often be missed unless one has a high index of suspicion. We describe a case of CMV colitis in a 78-year-old patient with no known risk factors for immunosuppression who was admitted for respiratory diseases and then subsequently developed transfusion dependent lower gastrointestinal bleeding. She ultimately required surgical resection of her colon. A literature review on CMV colitis, its myriad manifestations and therapeutic outcomes was conducted, with particular emphasis on its occurrence in immunocompetent patients.
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Affiliation(s)
- Lee June
- General Surgery Department, Changi General Hospital, Singapore, Singapore
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