Life-Threatening Cytomegalovirus Colitis In An Immunocompetent Patient: A Case Report

Yıl 2013, Cilt: 3 Sayı: 3, 72 - 76, 01.09.2013

Sevinç Şahin Esra Özhamam Sezer Kulaçoğlu Selda Seçkin

Öz

Cytomegalovirus is an opportunistic virus that can cause infection in any part of the gastrointestinal tract, mostly in immunocompromised patients and rarely in immunocompetent individuals. Cytomegalovirus infection almost always shows an aggressive course in immunocompromised patients, in contrary it is usually self-limited in immunocompetent individuals. But sometimes it produces severe manifestations in immunocompetent patients. Herein, we report a case of life-threatening cytomegalovirus colitis in an immunocompetent 79 year-old man. Cytomegalovirus colitis can be presented with clinical symptoms like abdominal pain, diarrhea, hematochezia, melena or fever. In endoscopic examination, ulceration, obstructive pseudomembrane formation, mucosal bleeding and/or inflammatory masses can be detected.
Histopathologically, inflammatory processes ranging from minimal inflammation to deep ulcers or extensive necrosis can be observed in a wide spectrum. The characteristic histopathological feature is intranuclear or intracytoplasmic “owl’s eye” viral inclusions. A brief summary about cytomegalovirus infection in immunocompetent individuals and differential diagnosis are also given in this report.

Anahtar Kelimeler

Cytomegalovirus, Colitis, Opportunistic infections

İMMÜNKOMPETAN BİR HASTADA HAYATI TEHDİT EDEN SİTOMEGALOVİRÜS KOLİTİ: BİR OLGU SUNUMU

Öz

Sitomegalovirüs, çoğunlukla immün yetmezliği olan hastalarda ve nadiren de immün- kompetan kişilerde gastrointestinal sistemin herhangi bir yerinde enfeksiyona yol açabi- len fırsatçı bir virüstür. Sitomegalovirüs enfeksiyonu immün yetmezliği olan hastalarda hemen her zaman agresif bir seyir gösterir iken tersine immünkompetan bireylerde ge- nellikle kendi kendini sınırlayan bir seyir gösterir. Ancak bazen immünkompetan kişilerde de ciddi tablolara neden olabilir. Biz bu olgu sunumunda 79 yaşında immünkompetan erkek hastada görülen hayatı tehdit eden sitomegalovirüs enfeksiyonunu sunuyoruz. Si- tomegalovirüs koliti karın ağrısı, diare, hematokezya, melena veya ateş gibi klinik semp- tomlar ile kendini gösterebilir. Endoskopik olarak, ülserasyon, obstruktif psödomembran oluşumu, mukozal kanama ve/veya inflamatuar kitleler görülebilir. Histopatolojik olarak, minimal inflamasyondan derin ülserlere veya yaygın nekrozlara kadar değişen geniş bir spektrumda inflamatuar proçes gözlenebilir. Karakteristik histopatolojik özelliği intra- nükleer veya intrasitoplazmik “baykuş gözü” şeklindeki viral inklüzyonlardır. Bu bildiride ayrıca immünkompetan bireylerde görülen sitomegalovirüs enfeksiyonu ve ayırıcı tanı ile ilgili kısa bir özet de sunulmuştur.

Anahtar Kelimeler

Sitomegalovirüs, Kolit, Fırsatçı enfeksiyonlar

Kaynakça

• Mervan B. Evaluation of cytomegalovirus infection cases followed in hospital. Bakırköy Tıp Dergisi 2013; 9(1):39-41.
• Lamps LW. Infectious Diseases of the Colon. In: Lacobuzio-Donahue CA, Montgomery E, eds. Gastrointestinal and Liver Pathology. 2nd ed. Philadelphia: Elsevier Saunders, 2012;297-304.
• Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review.Virol J 2008;5(3):47-55.
• Momin N, Telisinghe PU, Chong VH. Cytomegalovirus colitis in immunocompetent patients. Singapore Med J 2011;52(9):170-2.
• Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 2005; 50(4):609-16.
• Karakozis S, Gongora E, Caceres M, Brun E, Cook JW. Life-threatening cytomegalovirus colitis in the immunocompetent patient: report of a case and review of the literature. Dis Colon Rectum 2001; 44(11):1716-20.
• Lamps LW. Infectious Disorders of the GI Tract. In: Odze RD, Goldblum RJ, eds. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. 2nd ed. Philadelphia: Elsevier Saunders, 2009:52-80.
• Wang HH. Diagnostic Cytology of the GI Tract. In: Odze RD, Goldblum RJ, eds. Surgical Pathology of the GI Tract, Liver, Bilary Tract and Pancreas. 2nd ed. Philadelphia: Elsevier Saunders, 2009:42.
• Carter D, Olchovsky D, Pokroy R, Ezra D. Cytomegalovirus-associated colitis causing diarrhea in an immunocompetent patient. World J Gastroenterol 2006; 12(42):6898-9.
• Yan Z, Nguyen S, Poles M, et al. Adenovirus colitis in human immunodeficiency virus infection: an underdiagnosed entity. Am J Surg Pathol 1998; 22(9):101-6.