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Ninomiya R, Omi T, Kato T, Mayumi N, Kawarasaki M, Kawana S. IgA vasculitis complicated by cytomegalovirus enteritis: a case report. J NIPPON MED SCH 2014; 81:48-52. [PMID: 24614396 DOI: 10.1272/jnms.81.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 61-year-old man was admitted to our department with purpura and hemorrhagic bullae on his lower limbs, dull pain affecting the entire abdomen, and hematochezia. Histopathological examination and immunostaining revealed leukocytoclastic vasculitis of the small blood vessels of the dermis and IgA deposition; multiple ulcers were observed in the ileum during lower gastrointestinal (GI) endoscopy, so we made a diagnosis of IgA vasculitis (Henoch-Schönlein). Treatment with oral prednisolone (PSL) at a dose of 80 mg/day (1 mg/kg/day) for one week resolved the symptoms almost completely. However, when the PSL dose was later reduced, dull epigastric pain and discomfort flared up again. Multiple punched-out ulcers were observed in the duodenum during upper GI endoscopy, and immunostaining revealed cytomegalovirus (CMV) in vascular endothelial cells and infiltrating cells. The patient's serum was positive for CMV antigenemia. On the basis of these findings, we concluded that the CMV enteritis had developed as a complication arising from the patient's immunosuppressed state, which was itself a result of the steroid therapy. We treated the patient with ganciclovir, which relieved the abdominal symptoms.
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Chen YM, Hung YP, Huang CF, Lee NY, Chen CY, Sung JM, Chang CM, Chen PL, Lee CC, Wu YH, Lin HJ, Ko WC. Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:345-9. [PMID: 23481408 DOI: 10.1016/j.jmii.2013.01.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 09/23/2012] [Accepted: 01/25/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE(S) To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. METHODS Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. RESULTS Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8, 57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3 ± 1.3 kg/m(2)) and hypoalbuminemia (25 ± 7.0 g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. CONCLUSION CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.
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Affiliation(s)
- Yao-Ming Chen
- Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan
| | - Yuan-Pin Hung
- Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Fang Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chiung-Yu Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Junne-Ming Sung
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ming Chang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Chi Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Hui Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, PingTung Christian Hospital, PingTung, Taiwan
| | - Hsiao-Ju Lin
- Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan.
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Gastrointestinal manifestations of Henoch-Schonlein Purpura. Dig Dis Sci 2008; 53:2011-9. [PMID: 18351468 DOI: 10.1007/s10620-007-0147-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 11/24/2007] [Indexed: 12/11/2022]
Abstract
Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. The diagnostic criteria include palpable purpura with at least one other manifestation -- abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Immune complex deposits result in necrosis of the wall of small- and medium-sized arteries with infiltration of tissue by neutrophils and deposition of nuclear fragments, a process called leukocytoclastic vasculitis (LCV). It is often associated with infections, medications, or tumors. It may coexist with or mimic Crohn's disease. Periumbilical and epigastric pain worsens with meals, from bowel angina. Bleeding is usually occult or, less commonly, associated with melena. Intussusception, the most common surgical complication, is usually ileo-ileo or ileo-colic. Perforations, usually ileal, may occur spontaneously or be associated with intussusception. Ultrasound, recommended as the first diagnostic test, and CT scans may show intussusception and asymmetric bowel wall thickening mainly involving the jejunum and ileum. There are a range of endoscopic findings including gastritis, duodenitis, ulceration, and purpura, with the second portion of the duodenum characteristically being involved more than the bulb. Intestinal biopsies show IgA deposition and LCV in the submucosal vessels. Superficial biopsies may show inflammation, ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia. The efficacy of corticosteroids in preventing severe complications or relapses is controversial. The majority of patients, however, improve spontaneously.
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Vlahos K, Theodoropoulos GE, Lazaris AC, Agapitos E, Christakopoulos A, Papatheodorou D, Kalogreas G, Tahteris E. Isolated colonic leukocytoclastic vasculitis causing segmental megacolon: report of a rare case. Dis Colon Rectum 2005; 48:167-71. [PMID: 15690676 DOI: 10.1007/s10350-004-0758-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. Deterioration of his clinical picture along with leukocytosis and radiographic evidence of severe colonic dilation rendered exploratory laparotomy necessary. Greatly distended and inflamed transverse and descending colon were evident and an extended left colectomy was performed. Characteristic changes of leukocytoclastic vasculitis in the serosal and muscular layers of the resected colon were demonstrated at histopathologic examination. Systemic leukocytoclastic vasculitis, usually coexisting with Henoch-Schonlein purpura, commonly affects the small bowel with clinical evidence of ischemia or bleeding. Colon involvement is infrequently reported in the context of systemic disease. Isolated colonic leukocytoclastic vasculitis without extraintestinal manifestations is rare. A previously unreported case of localized leukocytoclastic vasculitis of the left colon resulting in the impressive presentation of megacolon, without the presence of any precipitating factor or associated systemic disease is presented here, with an overview of the related literature.
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Affiliation(s)
- Kostas Vlahos
- Department of Surgery, Samos Military Hospital, Samos Island, Greece
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