Apoptotic colopathy in a pediatric autologous bone marrow transplantation patient with spontaneous colonic cast excretion: Is it due to GVHD or rotavirus infection?

Year 2021, Volume: 5 Issue: 5, 550 - 552, 01.05.2021

Payam Hacısalihoğlu , Baris Malbora , Mustafa Okumuş , Hakan Sarbay

https://doi.org/10.28982/josam.788764

Abstract

Spontaneous colonic cast excretion per anus is a very rare entity. Colonic ischemia and severe infections are the most common etiologic factors. It is mostly seen in adults. Only one pediatric patient with colonic cast excretion was reported in the literature. We present a three-year-old male patient with the diagnosis of neuroblastoma who had undergone autologous BMT. After suffering a prolonged rotavirus infection, on the 25th the post-transplantation day, he presented with nausea, vomiting, abdominal pain, and spontaneous excretion of colonic mucosa-like material via defecation. The histopathological interpretation of the excreted material revealed acellular material composed of fibrin and neutrophils. The patient’s colonoscopic biopsy specimen revealed crypt distortion, regeneration, and numerous apoptotic bodies within the crypt epithelium. Apoptotic colopathy and colonic cast excretion per anus is a sign of ischemia, which may be caused by severe intestinal infections or rarely, graft-versus-host disease. Therefore, a clinicopathological correlation was performed to reach a definitive diagnosis. The patient’s symptoms were attributed to severe, prolonged rotavirus infection.

Keywords

Allogeneic, Bone marrow transplantation, Colonic cast, Rotavirus, GvHD

References

• 1. Samee A, Kirby RM, Brunt AM. Passage of intestinal (small bowel) cast-an an unusual complication of neutropenic sepsis. BMJ Case Rep. 2010;23;2010:bcr0420102924. doi: 10.1136/bcr.04.2010.2924.
• 2. Abe S, Yamaguchi H, Murono K, Kanazawa T, Ishihara S, Sunami E, et al. Passage of a sigmoid colon cast in a patient with ischemic colitis. Int Surg. 2014;99:500-5.
• 3. Sternberg SS. Acute Gastrointestinal Graft versus Host Syndrome. In: Sternberg SS, Mills SE, Carter D, eds. Sternberg Diagnositic Surgical Pathology. Philadelphia: Lippincott Williams & Wilkins; 2004. pp. 1490.
• 4. Mantas D, Damaskos C, Bamias G, Dimitroulis D. Colonic casts: unexpected complications of colonic ischaemia. Ann R Coll Surg Engl. 2016;98:e109-10.
• 5. Nambu R, Hagiwara SI, Kubota M, Kagimoto S. Colon Casts Excreted in a Child. JPediatr Gastroenterol Nutr. 2017;65:e43.
• 6. Al Ashgar H, Peedikayil M, Chaudhri N, Al-Ghamdic A. Defecation of a “colon cast” as a rare presentation of acute graft-versus-host disease. Ann Saudi Med. 2009;29:231-3.
• 7. Alonso S, Cabrero M, Caballero JC, Dávila J, de la Calle VG, López-Godino O, et al. Acute graft-versus-host disease and bronchiolitis obliterans after autologous stem cell transplantation in a patient with multiple myeloma. Clin Case Rep. 2015;3:370-5.
• 8. Nakamura H, Nakao T, Ujiie H, Karasuno T, Teshima H, Komatsu K, et al. Induction of autologous graft-versus-host disease after autologous peripheral blood stem cell transplantation. J Allergy Clin Immunol. 1999;103:457-61.
• 9. Cox GJ, Matsui SM, Lo RS, Hinds M, Bowden RA, Hackman RC, et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology. 1994;107:1398-07.
• 10. Liakopoulou E, Mutton K, Carrington D, Robinson S, Steward CG, Goulden NJ, et al. Rotavirus as a significant cause of prolonged diarrhoeal illness and morbidity following allogeneic bone marrow transplantation. Bone Marrow Transplant. 2005;36:691-4.
• 11. Celep G. New targets for Turkish childhood national immunization schedule. J Surg Med. 2020;4(6):432-7.
• 12. Chaïbi C, Cotte-Laffitte J, Sandré C, Esclatine A, Servin AL, Quéro AM, et al. Rotavirus induces apoptosis in fully differentiated human intestinal Caco-2 cells. Virology. 2005;332:480-90.
• 13. Alfajaro MM, Cho KO. Evidences and consequences of extra-intestinal spread of rotaviruses in humans and animals. VirusDis. 2014;25:186-94.
• 14. Boshuizen JA, Reimerink JH, Korteland-van Male AM, van Ham VJ, Koopmans MP, Büller HA, et al. Changes in small intestinal homeostasis, morphology, and gene expression during rotavirus infection of infant mice. J Virol. 2003;77:13005-16.
• 15. Weber A, Marques-Maggio E. Apoptotic colonopathy under immunosuppression: mycophenolate-related effects and beyond. Pathobiology. 2013;80:282-8.