Pancolitis associated with higher mortality risk of cytomegalovirus colitis in patients without inflammatory bowel disease

Dasatinib-induced colitis: clinical, endoscopic and histological findings

BACKGROUND

Dasatinib, a second-generation tyrosine kinase inhibitor, is widely used in patients with haematological malignancies. The main side effects of dasatinib are myelosuppression and pleural effusion; however, colitis, such as haemorrhagic colitis and cytomegalovirus (CMV) colitis, have been reported as rare side effects. There are only a few studies conducted on dasatinib-induced colitis.

AIMS

This study aimed to clarify the clinical, endoscopic and pathological features of dasatinib-induced colitis.

METHODS

This retrospective study included 51 consecutive patients who received dasatinib therapy between June 2009 and July 2020. Dasatinib-induced colitis was defined as the presence of colitis symptoms, exclusion of other diseases that could cause colitis, and improvement in symptoms after dasatinib withdrawal or dose reduction. CMV positivity was determined based on the positive result of CMV immunostaining.

RESULTS

Dasatinib-induced colitis was diagnosed in nine of 51 patients (17.6%), and most of the symptoms were mild diarrhoea and bloody stools. The endoscopic findings were characterised by loss of vascular pattern (100%) and multiple small erosions (83.3%) which were mainly found in the transverse and descending colon. In a patient who underwent follow-up colonoscopy once a year while taking dasatinib, endoscopic findings changed from initial erythematous spots to multiple erosions, and finally to multiple small round elevations with erosion on the top that disappeared after discontinuation of dasatinib. Anti-CMV therapy was administered to one patient, but the treatment failed. All patients with dasatinib-induced colitis were cured after the discontinuation of dasatinib.

CONCLUSION

Physicians should consider CMV reactivation to manage dasatinib-induced colitis.

Cytomegalovirus Diseases of the Gastrointestinal Tract

Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract can be fatal. However, very few studies have provided comprehensive analyses and specified the differences in symptoms observed in different parts of the GI tract. This study aimed to comprehensively analyze clinical manifestations and management of GI CMV disease. This retrospective cohort study enrolled the patients who had CMV diseases of the GI tract proved by CMV immunohistochemistry stain from the pathology database in a 4000-bed tertiary medical center between January 2000 and May 2021. The patient characteristics, clinical manifestations, endoscopic features, treatments, outcomes, and prognostic factors were analyzed. A total of 356 patients were enrolled, including 46 infected in the esophagus, 76 in the stomach, 30 in the small intestine, and 204 in the colon. In total, 49.4% patients were immunocompromised. The overall in-hospital mortality rate was 20.8%: CMV enteritis had the highest rate (23.3%). Sixty percent of patients received antiviral treatment and 16% were administered both intravenous and oral anti-viral drugs (Combo therapy, minimal and mean treatment duration were 14 and 39.9 ± 25 days). Prognostic factors of in-hospital mortality included age, immune status, albumin level, platelet count, GI bleeding, time-to-diagnosis, and Combo therapy. In the survival analysis, immunocompetent patients receiving Combo therapy had the best survival curve, and immunocompromised patients receiving non-Combo therapy had the worst survival curve. Combo therapy ≥14 days resulted in a better outcome for both immunocompromised and immunocompetent patients. In conclusion, CMV GI diseases affect both immunocompromised and immunocompetent hosts, and a complete treatment course should be considered for patients with poor prognostic factors.

Clinical manifestations, risk factors, and prognostic factors of cytomegalovirus enteritis

BACKGROUND

To comprehensively analyze the risk factors, clinical characteristics, outcomes, and prognostic factors of Cytomegalovirus (CMV) enteritis.

METHODS

This retrospective cohort study enrolled patients who had undergone pathological examinations for CMV enteritis. They were divided into CMV and non-CMV groups according to immunohistochemistry staining results. The risk factors, clinical presentations, endoscopic features, treatments, outcomes, and prognostic factors of CMV enteritis were then analyzed.

RESULTS

Forty-two patients (18 CMV, 24 non-CMV group) were included in the study. Major clinical presentations in the CMV group included gastrointestinal bleeding (72.2%), abdominal pain (55.6%), and fever (33.3%); ulcers (72.2%) were the most common endoscopic findings. In-hospital and overall mortality rates were 27.8% and 38.9%, respectively; and longer hospital stays and higher overall mortality rates were observed. Radiotherapy and C-reactive protein levels were prognostic factors for in-hospital mortality. The risk factors for CMV enteritis included immunocompromised status (p = 0.013), steroid use (p = 0.014), shock (p = 0.031), concurrent pneumonia (p = 0.01), antibiotic exposure (p < 0.001), radiotherapy (p = 0.027), chronic kidney disease (p = 0.041), and CMV colitis (p = 0.031).

CONCLUSIONS

Physicians should pay attention to the characteristics of CMV enteritis in high-risk patients to make an early diagnosis and potentially improve the clinical outcome.

Cytomegalovirus gastritis: Clinicopathological profile

BACKGROUND

Cytomegalovirus (CMV) gastritis is occasionally reported in case reports and limited case series. Up to now, it is the largest and most comprehensive retrospective study of CMV gastritis.

METHODS

All patients who were histologically diagnosed with CMV gastritis at Linkou Chang Gung Memorial Hospital between January 2000 and April 2020 were included. Patients were divided into two groups according to immunity. Between-group differences in characteristics, manifestations, endoscopic features, prognostic factors, and outcomes were analyzed. The main endpoint was 3-month mortality.

RESULTS

A total of 54 patients (34 immunocompromised, 20 immunocompetent) were enrolled. Common presentations included gastrointestinal bleeding (35.2%), abdominal pain (33.3%) and fever (31.5%). The endoscopic features included ulcer (88.9%) and inflammation (11.1%). The 3-month mortality rate was 20.4% and overall mortality rate was 40.7%. Acute kidney injury was the only independent risk factor for 3-month mortality (OR 53.89, 95%CI 1.56-1861.73, p = 0.027). Anti-viral therapy and host immune status did not affect 3-month mortality.

CONCLUSION

Both immunocompromised and immunocompetent patients with CMV gastritis have high mortality rates, without significant between-group differences. Acute kidney injury is the only independent predictive factor for 3-month mortality. Prevention of acute kidney injury may possibly improve the 3-month mortality rate.

Clinical features and treatment of inflammatory bowel disease in a low-incidence area: A hospital-based retrospective cohort study in Taiwan

Inflammatory bowel disease (IBD) has emerged in the Asia-Pacific area over the past 2 decades. There is a paucity of clinical data regarding real-world experience of patients with IBD from low endemic area such as Taiwan. Therefore, the present study aimed to review the clinical features of patients with IBD form a tertiary center from Taiwan.A total of 163 patients with IBD were identified from the electronic clinical database of Changhua Christian Hospital. Demographic data of the patients and clinical features of the disease pattern were retrospectively reviewed.There was a higher proportion (62.6%) of patients diagnosed with ulcerative colitis (UC). Patients with Crohn disease (CD) and UC had male predominance. The median age of diagnosis was younger in patients with CD than in patients with UC (CD vs UC: 31 vs 40 years, P = .0423). The disease distribution of UC was as follows: E1 (15.7%), E2 (47.1%), and E3 (37.3%). The disease distribution of CD was as follows: L1 (36.1%), L2 (14.8%), L3 (42.6%), and L4 (6.5%). The majority of patients with CD had a complicated presentation with B2 (32.8%) and B3 (32.8%). Patients with CD had a higher bowel resection rate than patients with UC. Patients with CD were more likely to be treated with immunomodulator and biologics and those with UC were more likely to be treated with 5-aminosalicylic acid (5-ASA). A trend of decreased bowel resection for patients with IBD and less severe phenotype of patients with CD were observed after 2015.UC with male predominance was the predominant type of IBD in the study. Patients with CD are likely to have a complicated disease course, requiring a higher demand of biologic therapy than patients with UC.

Cytomegalovirus Colitis with a Cobblestone Appearance

Cytomegalovirus (CMV) colitis with a cobblestone appearance is rare, and its endoscopic and pathological features remain poorly described. A 78-year-old woman was admitted to our hospital for disturbance of consciousness, high-grade fever, and diarrhea occurring up to 7 times a day. Sigmoidoscopy revealed a circumferential ulcer with mucosal defect, an ulcer with a cobblestone appearance extending from the upper rectum to the sigmoid colon, and an irregular ulcer on the lower rectum. She was histopathologically diagnosed with CMV colitis and intravenously treated with ganciclovir (5 mg/kg) for 7 weeks. Colonoscopy after treatment revealed an improvement of the ulcers extending from the rectum to the sigmoid colon, but no significant improvement of her general condition. She died from sepsis 4 months after hospitalization. To our knowledge, this report represents a valuable addition to the CMV literature describing a rare case of CMV colitis with a cobblestone appearance.