Cytomegalovirus ileitis with protein-losing enteropathy in an immunocompetent adult
Tóm tắt
Symptomatic cytomegalovirus (CMV) infection in immunocompetent hosts has traditionally been considered to have a benign, self-limited course, and those who need intensive therapy are rare. Moreover, there are few reports of CMV infection with protein-losing enteropathy (PLE). We present an immunocompetent 74-year-old woman with CMV ileitis with PLE, which was diagnosed due to severe hypoalbuminemia and edema of the lower extremities. The patient was not immunocompromised, because a human immunodeficiency virus (HIV) antibody test was negative and she had not been taking immunosuppressants. Imaging tests including colonoscopy revealed ileitis with shallow widespread ulcers. 99mTc-human serum albumin (HAS-D) scintigraphy suggested a possibility of protein loss in the ileum based on selective accumulation of nuclides in the right abdomen. Histological findings of the biopsy showed ulcerative mucosa with abnormal cells, which had enlarged nuclei with intranuclear inclusion bodies, including typical Cowdry A type. In immunohistochemistry, these cells were positive for anti-CMV staining. She was successfully treated with medical treatments including intravenous injection of ganciclovir (GCV) (500 mg/day). We described an extremely rare case of CMV ileitis with PLE in an immunocompetent adult who was treated successfully with medical treatments, including GCV.
Tài liệu tham khảo
Rafailidis PI, Mourtzoukou EG, Varbobitis IC, et al. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008;5:47.
Elli L, Topa M, Rimondi A. Protein-losing enteropathy. Curr Opin Gastroenterol. 2020;36:238–44.
Staras SA, Dollard SC, Radford KW, et al. Seroprevalence of cytomegalovirus infection in the United States, 1988–1994. Clin Infect Dis. 2006;43:1143–51.
Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34:1094–7.
Al-Omari A, Aljamaan F, Alhazzani W, et al. Cytomegalovirus infection in immunocompetent critically ill adults: literature review. Ann Intensive Care. 2016;6:110.
Jang EY, Park SY, Lee EJ, et al. Diagnostic performance of the cytomegalovirus (CMV) antigenemia assay in patients with CMV gastrointestinal disease. Clin Infect Dis. 2009;48:e121–4.
Frantzeskaki FG, Karampi ES, Kottaridi C, et al. Cytomegalovirus reactivation in a general, nonimmunosuppressed intensive care unit population: incidence, risk factors, associations with organ dysfunction, and inflammatory biomarkers. J Crit Care. 2015;30:276–81.
Galiatsatos P, Shrier I, Lamoureux E, et al. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005;50:609–16.
Karigane D, Takaya S, Seki Y, et al. Cytomegalovirus enteritis in immunocompetent subjects: a case report and review of the literature. J Infect Chemother. 2014;20:325–9.
Schmucker DL, Heyworth MF, Owen RL, et al. Impact of aging on gastrointestinal mucosal immunity. Dig Dis Sci. 1996;41:1183–93.
Perrineau S, Cazals-Hatem D, Zarrouk V, et al. Cytomegalovirus-associated protein-losing enteropathy in a healthy man. Med Mal Infect. 2017;47:562–5.
Underwood JC, Corbett CL. Persistent diarrhoea and hypoalbuminaemia associated with cytomegalovirus enteritis. Br Med J. 1978;1:1029–30.
Nakase H, Itani T, Mimura J, et al. Transient protein-losing enteropathy associated with cytomegalovirus infection in a noncompromised host: a case report. Am J Gastroenterol. 1998;93:1005–6.
Chae EY, Lee SS, Chung JW, et al. Cytomegalovirus enterocolitis in apparently immunocompetent hosts: evaluation of the radiologic findings and clinical features. J Comput Assist Tomogr. 2010;34:892–8.
Chen S, Lalazar G, Barak O, et al. Protein-loosing entropathy induced by unique combination of CMV and HP in an immunocompetent patient. Case Rep Med. 2012;2012:361892.