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Sinagra E, Raimondo D, Gallo E, Calvaruso M, Lentini VL, Cannizzaro A, Linea C, Giunta M, Montalbano LM, D'Amico G, Rizzo AG. Could JC virus be linked to chronic idiopathic intestinal pseudo-obstruction? Clin J Gastroenterol 2019; 13:377-381. [PMID: 31728918 DOI: 10.1007/s12328-019-01069-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 11/02/2019] [Indexed: 12/12/2022]
Abstract
JC virus is a member of the Polyomavirus family, infects humans worldwide, and 90% of the population carry antibodies to the virus by adult life. The initial infection is asymptomatic, but it may become persistent. JC virus DNA is frequently present in the upper and lower gastrointestinal tracts of healthy adults. Chronic idiopathic intestinal pseudo-obstruction, one of the most severe gastrointestinal motility disorders, is a condition characterized by a clinical picture mimicking small bowel occlusion with related symptoms and signs in the absence of demonstrable mechanical obstruction. Because of the known neuropathic capability of this virus, and its frequent presence in the gut, it has been proposed that JCV might be detectable in tissues of patients with chronic idiopathic intestinal pseudo-obstruction, and possibly be involved in the pathogenesis of this disease, because the virus may actively infect the enteroglial cells of the myenteric plexuses of the patients with chronic idiopathic intestinal pseudo-obstruction. We report two cases of upper idiopathic intestinal pseudo-obstruction associated with JCV infection.
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Affiliation(s)
- Emanuele Sinagra
- Endoscopy Unit, Contrada Pietra Pollastra Pisciotto, Fondazione Istituto San Raffaele-G. Giglio, 90015, Cefalù, Italy
- Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Dario Raimondo
- Endoscopy Unit, Contrada Pietra Pollastra Pisciotto, Fondazione Istituto San Raffaele-G. Giglio, 90015, Cefalù, Italy
| | - Elena Gallo
- Unit of Pathology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Marco Calvaruso
- Contrada Pietra Pollastra Pisciotto, Istituto Di Bioimmagini E Fisiologia Molecolare, IBFM-CNR, 90015, Cefalù, Italy
| | - Vincenzo Luca Lentini
- Unit of Pathology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy.
| | - Alessandra Cannizzaro
- Unit of Pathology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Cristina Linea
- Unit of Gastroenterology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Marco Giunta
- Unit of Gastroenterology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Luigi Maria Montalbano
- Unit of Gastroenterology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Gennaro D'Amico
- Unit of Gastroenterology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
| | - Aroldo Gabriele Rizzo
- Unit of Pathology, Ospedali Riuniti "Villa Sofia-Cervello, University of Palermo, via trabucco 180, 90136, Palermo, Italy
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Abstract
A 30-year-old HIV-infected intravenous drug user presented with sepsis, acute renal failure, oedema, proteinuria and iron deficiency anaemia. After extensive investigation, a diagnosis of reactive systemic AA (amyloid, serum amyloid A protein) amyloidosis was made on the basis of renal, gastric and duodenal biopsies.
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Affiliation(s)
- C Newey
- T8, University College London Hospitals, London NW1 2BU, UK
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Kelesidis T, Tozzi S, Mitty R, Worthington M, Fleisher J. Cytomegalovirus pseudotumor of the duodenum in a patient with AIDS: an unrecognized and potentially treatable clinical entity. Int J Infect Dis 2010; 14:e274-82. [PMID: 19695917 PMCID: PMC8055438 DOI: 10.1016/j.ijid.2009.04.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/04/2009] [Accepted: 04/08/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) is a common pathogen affecting the gastrointestinal tract in patients with AIDS. We report a case of CMV-induced pseudotumor of the duodenum in a patient with AIDS and review other reported cases of CMV-induced pseudotumors in the gastrointestinal tract. CMV-induced pseudotumor in patients with AIDS is an exceptionally rare clinical entity, and to our knowledge no reports have previously summarized this clinical entity. METHODS All previous cases included in our literature review were found using a PubMed search (1980-November 2008) of the English-language medical literature applying the terms 'CMV infection', 'inflammatory mass', 'pseudotumor', and 'gastrointestinal tract'. The references cited in these articles were examined to identify additional reports. RESULTS Although CMV-induced duodenitis has been described in patients with HIV infection, to our knowledge CMV-induced pseudotumor of the duodenum has not been previously reported in the literature. We describe the first case of an AIDS patient with CMV pseudotumor responding to oral treatment with valganciclovir with complete resolution of the CMV mass. Among reports of non-duodenal pseudotumor reported in the English literature, we found only 14 cases of CMV-induced gastrointestinal pseudotumors in HIV-positive patients. The clinical manifestations, pathologic findings of the CMV pseudotumors, as well as the treatment and outcome of these HIV patients are reviewed. CONCLUSION CMV pseudotumor should be included in the differential diagnosis of gastrointestinal mass lesions in AIDS patients and in other immunocompromised patients. The tumor often responds to antiviral therapy, but resolution of a CMV mass as a result of oral antiviral therapy has not been previously described. Since pseudotumors secondary to CMV often respond to medical treatment, it is important that the physicians treating severely immunocompromised patients are aware of this entity.
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Affiliation(s)
- Theodoros Kelesidis
- Division of Infectious Diseases, Department of Medicine, Caritas St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135, USA.
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Abstract
OBJECTIVE Cytomegalovirus (CMV) infection is known to cause ulcerations, erosion and mucosal haemorrhage in the gastrointestinal tract. The aim of this study was to report the CMV findings in the gastroduodenal mucosa of kidney transplantation patients and immunocompetent controls. MATERIAL AND METHODS Forty-six kidney transplant patients with upper gastrointestinal symptoms and 43 immunocompetent, dyspeptic patients (controls) prospectively underwent oesophagogastroduodenoscopies (OEGDs), with biopsies from the duodenum and stomach. CMV was demonstrated by immunohistochemistry, both in frozen sections using a monoclonal antibody against CMV-specific antigens (pp65 matrix protein) and in paraffin sections by means of a monoclonal antibody against the delayed early protein (p52). RESULTS CMV was detected in the gastric mucosa in 30% of the kidney transplant patients and in 9% of the controls (p<0.05) and in the duodenal mucosa in 70% and 35%, respectively (p<0.01). The total frequency of CMV findings was similar in patients who underwent OEGDs <1 year and >1 year after transplantation. CMV inclusions were found only in transplantation patients <1 year after transplantation (n=9). CMV findings, especially inclusions, in the gastric biopsies were associated with nausea and upper gastric pain. Histopathological findings in CMV-positive samples were non-specific, focal inflammation in haematoxylin-eosin-stained preparations, while CMV p52 staining showed inclusions in either the epithelial or endothelial cells. CONCLUSIONS CMV could be detected in the gastroduodenal mucosa in 74% of kidney transplantation patients and in 40% of immunocompetent controls (p<0.01). CMV diagnostics are always recommended when gastroduodenal biopsies of kidney transplantation patients are performed.
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Affiliation(s)
- Susanna Sarkio
- Department of Transplantation Surgery, Helsinki University Hospital, Helsinki, Finland
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Péter A, Telkes G, Varga M, Sárváry E, Kovalszky I. Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single-center experience. Clin Transplant 2004; 18:580-4. [PMID: 15344964 DOI: 10.1111/j.1399-0012.2004.00230.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) is considered to be the major cause of upper gastrointestinal (GI) symptoms in organ transplant recipients. In the diagnosis of GI CMV infection the detection of the virus in the mucosa is essential. The aim of the study was to evaluate the significance of CMV, detected in biopsy specimens from stomach and duodenum of solid organ transplant recipients. METHODS Data of 227 elective upper endoscopies on symptomatic organ transplant recipients were evaluated for clinical symptoms, endoscopic changes and conventional histologic alterations of mucosal biopsy samples. Qualitative PCR was performed for detection of the presence of CMV-DNA in each biopsy materials. RESULTS CMV-DNA was detected in biopsy samples of 91 patients (40.1%) while only in 20 cases (8.8%) the signs of CMV infections were found by conventional histology (p < 0.00001). No considerable differences could be observed in symptomatic, histologic alterations between CMV-PCR positive and negative groups. There were no endoscopic changes in 25.3% of CMV-PCR positive and 5.1% of negative patients. CONCLUSIONS Qualitative PCR is an accurate method for the detection of CMV in the mucosa of the GI tract. Further investigations are needed for determination of the exact pathological role of detected CMV.
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Affiliation(s)
- Antal Péter
- Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary.
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Dionisio D, Arista S, Vizzi E, Manneschi LI, Di Lollo S, Trotta M, Sterrantino G, Mininni S, Leoncini F. Chronic intestinal infection due to subgenus F type 40 adenovirus in a patient with AIDS. Scand J Infect Dis 1997; 29:305-7. [PMID: 9255895 DOI: 10.3109/00365549709019048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A case of chronic intestinal infection due to adenovirus type 40 lasting for 13 months in a patient with AIDS is described. Adenovirus particles were detected by electron microscopy in biopsy samples taken from the duodenum 3 months after the onset of diarrhoea. The virus was identified as adenovirus type 40 in stool samples by ELISA monoclonal antibodies to adenovirus group antigen (MAd-g2) and types 40 and 41 (MA 40-1 and MA 41-1). No other enteropathogens were found. These data support a causal relationship between adenovirus 40 and the gastrointestinal symptoms of the patient. This is the first reported case of intestinal infection caused by adenovirus type 40 in a patient with AIDS.
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Affiliation(s)
- D Dionisio
- Infectious Diseases Unit, Careggi Hospital, Florence, Italy
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