scholarly journals Enterocolic Fistula: A Rare Presentation of Cytomegalovirus Infection

2012 ◽  
Vol 23 (2) ◽  
pp. e41-e43 ◽  
Author(s):  
Richdeep S Gill ◽  
Geoffrey Taylor ◽  
Robert M Penner ◽  
Sarvesh Logsetty
Keyword(s):  
Cytomegalovirus Infection ◽  
Surgical Intervention ◽  
Present Report ◽  
Rare Complication ◽  
Immunocompromised Patients ◽  
Cmv Infection ◽  
Rare Presentation ◽  
Common Presentation ◽  
Colocutaneous Fistula ◽  
Cmv Colitis

In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.

scholarly journals Nonpulmonary manifestations of cytomegalovirus infection in immunocompromised patients.

1992 ◽  
Vol 5 (2) ◽  
pp. 204-210 ◽  
Author(s):  
W L Drew
Keyword(s):  
Cytomegalovirus Infection ◽  
Antiviral Agent ◽  
Central Nervous System Disease ◽  
Disease Diagnosis ◽  
Immunocompromised Patients ◽  
Gastrointestinal Infection ◽  
Cmv Infection ◽  
System Disease ◽  
Cmv Disease ◽  
Suppress Virus Replication

Nonpulmonary manifestations of cytomegalovirus (CMV) infection in immunocompromised patients include chorioretinitis, gastrointestinal infection, and central nervous system disease. Diagnosis of end organ disease, especially in the gastrointestinal tract, is best substantiated by histologic evidence of CMV inclusions. Positive cultures of CMV provide evidence for supporting infection but do not define actual end organ disease. Satisfactory treatment of the disease can be accomplished with ganciclovir or foscarnet, although these agents only suppress virus replication. In many instances, severe CMV-induced end organ disease in immunocompromised patients will progress despite treatment. In some instances, resistance to the antiviral agent is the basis for drug failure. Patients at high risk for CMV disease can be identified, and studies of prophylaxis are in progress.

Routine Hematoxylin and Eosin Stain Is Specific for the Diagnosis of Cytomegalovirus Infection in Gastrointestinal Biopsy Specimens

2018 ◽  
Vol 26 (6) ◽  
pp. 500-506 ◽  
Author(s):  
Ling Guo ◽  
Tom C. DeRoche ◽  
Ziyan T. Salih ◽  
Shadi A. Qasem
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Cytomegalovirus Infection ◽  
High Specificity ◽  
Immunocompromised Patients ◽  
Cmv Infection ◽  
Biopsy Specimens ◽  
Hematoxylin And Eosin ◽  
Hematoxylin And Eosin Stain ◽  
Positive Results

Background. Gastrointestinal cytomegalovirus (CMV) infection is a serious complication in immunocompromised patients; clinicians often expect expedited results for biopsy specimens. Our goal is to determine the accuracy of identification of CMV on hematoxylin and eosin (H&E) stain. Methods and Results. A total of 361 biopsy specimens from 273 patients with suspicion for CMV infection were retrieved. CMV was detected by immunohistochemistry (IHC) in 37 specimens acquired from 33 individual patients (average age = 54 years). Among the CMV-positive patients, 29 (88%) were reported to be immunosuppressed. Colon was the most common affected location. Of 37 CMV-positive specimens by IHC, 28 were positive by H&E (76%), 6 were negative (16%), and 3 were suspicious (8%). Of the 29 positive specimens on H&E, 28 were confirmed by IHC (97%) and 1 was indeterminate (3%). The sensitivity and specificity of H&E were 84% and 94%, respectively; the positive predictive value was 97%, and the negative predictive value was 93% ( P < .00001). Conclusion. Our results show that a preliminary diagnosis of CMV infection, based on H&E stains, can be reported with high specificity and low risk for false-positive results. Suspicious cases should be deferred pending the result of IHC stains.

scholarly journals An Atypical Cause of Atypical Chest Pain

2014 ◽  
Vol 25 (5) ◽  
pp. 253-254
Author(s):  
Ahmad Zaheen ◽  
Reed A Siemieniuk ◽  
Patrick Gudgeon
Keyword(s):  
Chest Pain ◽  
Septic Arthritis ◽  
Surgical Intervention ◽  
Present Report ◽  
Hiv Positive ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Atypical Chest Pain ◽  
Present Case Report ◽  
Manubriosternal Joint

The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition toStaphylococcus aureusbacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.

scholarly journals Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

2014 ◽  
Vol 6 (3) ◽  
Author(s):  
Bora Koc ◽  
Huseyin Yuce Bircan ◽  
Semsi Altaner ◽  
Ozlem Cinar ◽  
Umit Ozcelik ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Bleeding ◽  
Cytomegalovirus Infection ◽  
Alimentary Tract ◽  
Virus Infections ◽  
Cmv Infection ◽  
Non Hodgkin Lymphoma ◽  
Immunosuppressive Medications ◽  
Immunodeficiency Virus ◽  
Cmv Colitis

In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.

scholarly journals A rare presentation of ovarian fibrothecoma: a diagnosing dilemma

2018 ◽  
Vol 7 (4) ◽  
pp. 1654
Author(s):  
Kalaivani Logesh ◽  
Latha Prasanna
Keyword(s):  
Postmenopausal Woman ◽  
Stromal Cell ◽  
Surgical Intervention ◽  
Pelvic Mass ◽  
Accurate Diagnosis ◽  
Female Gonad ◽  
Rare Presentation ◽  
Ovarian Tumours ◽  
Benign Tumours

Ovarian Fibrothecoma are uncommon tumors of gonadal stromal cell origin accounting for 3-4% of all ovarian tumours. Ovarian fibrothecoma are composed of an admixture of fibrous and the comatous elements. The stromal cell tumors are probably the most inaccurately diagnosed tumor of the female gonad, clinically and histologically. Rarely benign tumours can present with elevated CA125. Here we discuss a rare presentation of Ovarian Fibrothecoma in a 52 years postmenopausal woman with large pelvic mass with ascites and elevated CA125 which we mistook for malignancy. Hence accurate diagnosis is more important before extensive surgical intervention.

scholarly journals Post-transplant absolute lymphocyte count predicts early cytomegalovirus infection after heart transplantation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minjae Yoon ◽  
Jaewon Oh ◽  
Kyeong-Hyeon Chun ◽  
Chan Joo Lee ◽  
Seok-Min Kang
Keyword(s):  
High Risk ◽  
Heart Transplantation ◽  
Immunosuppressive Therapy ◽  
Lymphocyte Count ◽  
Cytomegalovirus Infection ◽  
Absolute Lymphocyte Count ◽  
Cmv Infection ◽  
Igg Antibody ◽  
Post Transplant ◽  
The Relationship

AbstractImmunosuppressive therapy can decrease rejection episodes and increase the risk of severe and fatal infections in heart transplantation (HT) recipients. Immunosuppressive therapy can also decrease the absolute lymphocyte count (ALC), but the relationship between early post-transplant ALC and early cytomegalovirus (CMV) infection is largely unknown, especially in HT. We retrospectively analyzed 58 HT recipients who tested positive for CMV IgG antibody and received basiliximab induction therapy. We collected preoperative and 2-month postoperative data on ALC and CMV load. The CMV load > 1200 IU/mL was used as the cutoff value to define early CMV infection. Post-transplant lymphopenia was defined as an ALC of < 500 cells/μL at postoperative day (POD) #7. On POD #7, 29 (50.0%) patients had post-transplant lymphopenia and 29 (50.0%) patients did not. The incidence of CMV infection within 1 or 2 months of HT was higher in the post-transplant lymphopenia group than in the non-lymphopenia group (82.8% vs. 48.3%, P = 0.013; 89.7% vs. 65.5%, P = 0.028, respectively). ALC < 500 cells/μL on POD #7 was an independent risk factor for early CMV infection within 1 month of HT (odds ratio, 4.14; 95% confidence interval, 1.16–14.77; P = 0.029). A low ALC after HT was associated with a high risk of early CMV infection. Post-transplant ALC monitoring is simple and inexpensive and can help identify patients at high risk of early CMV infection.

scholarly journals Innovative method for Amplatzer device implantation in patients with bronchopleural fistulas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jisong Zhang ◽  
Huihui Hu ◽  
Li Xu ◽  
Shan Xu ◽  
Jihong Zhu ◽  
...  
Keyword(s):  
Present Report ◽  
Rare Complication ◽  
Bronchopleural Fistula ◽  
Rigid Bronchoscopy ◽  
New Approach ◽  
Device Implantation ◽  
Amplatzer Device ◽  
Field Of Vision ◽  
Duration Of Operation

Abstract Background Bronchopleural fistula (BPF) is a relatively rare complication after various types of pulmonary resection. The double-sided mushroom-shaped occluder (Amplatzer device, AD) has been gradually used for BPF blocking due to its reliable blocking effect. We have improved the existing AD implantation methods to facilitate clinical use and named the new approach Sheath-free method (SFM). The aim of the present report was to explore the reliability and advantages of the SFM in AD implantation. Methods We improved the existing implantation methods by abandoning the sheath of the AD and using the working channel of the bronchoscope to directly store or release the AD without general anesthesia, rigid bronchoscopy, fluoroscopy, or bronchography. A total of 6 patients (5 men and 1 woman, aged 66.67 ± 6.19 years [mean ± SD]) had BPF blocking and underwent the SFM in AD implantation. Results AD implantation was successfully performed in all 6 patients with the SFM, 4 persons had a successful closure of the fistula, one person died after few days and one person did not have a successful closure of the fistula. The average duration of operation was 16.17 min (16.17 ± 4.67 min [mean ± SD]). No patients died due to operation complications or BPF recurrence. The average follow-up time was 13.2 months (range 10–17 months). Conclusion We observed that the SFM for AD implantation—with accurate device positioning and a clear field of vision—is efficient and convenient. The AD is effective in BPF blocking, and could contribute to significantly improved symptoms of patients.

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

Early-life environment influencing susceptibility to cytomegalovirus infection: evidence from the Leiden Longevity Study and the Longitudinal Study of Aging Danish Twins

2011 ◽  
Vol 140 (5) ◽  
pp. 835-841 ◽  
Author(s):  
L. H. MORTENSEN ◽  
A. B. MAIER ◽  
P. E. SLAGBOM ◽  
G. PAWELEC ◽  
E. DERHOVANESSIAN ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Human Cytomegalovirus ◽  
Family Environment ◽  
Early Life ◽  
Cytomegalovirus Infection ◽  
Genetic Factors ◽  
The Elderly ◽  
Same Sex ◽  
Cmv Infection ◽  
Early Life Environment

SUMMARYHuman cytomegalovirus (CMV) is a common herpesvirus establishing lifelong persisting infection, which has been implicated in immunosenescence and mortality in the elderly. Little is known about how and when susceptibility to CMV infection is determined. We measured CMV seroprevalence in two genetically informative cohorts. From the Leiden Longevity Study (LLS) we selected long-lived sib-pairs (n=844) and their middle-aged offspring and the offspring's partners (n=1452). From the Longitudinal Study of Aging Danish Twins (LSADT) 604 (302 pairs) same-sex monozygotic (MZ) and dizygotic (DZ) twins aged 73–94 years were included (n=302 pairs). Offspring of the long-lived LLS participants had significantly lower seroprevalence of CMV compared to their partners (offspring: 42%vs. partners: 51%,P=0·003). Of 372 offspring living with a CMV-positive partner, only 58% were infected. The corresponding number for partners was 71% (P<0·001). In the LSADT, MZ and DZ twins had high and similar CMV-positive concordance rates (MZ: 90%vs. DZ: 88%,P=0·51) suggesting that shared family environment accounts for the similarity within twin pairs. Our findings suggest that susceptibility to CMV infection – even under continuous within-partnership exposure – appears to be more strongly influenced by early-life environment than by genetic factors and adult environment.

CMV pneumonitis in a patient with Crohn’s disease taking azathioprine

2021 ◽  
Vol 14 (4) ◽  
pp. e241256
Author(s):  
Timothy Zef Hawthorne ◽  
Rachel Shellien ◽  
Lucy Chambers ◽  
Graham Devereux
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Low Dose ◽  
Antiviral Treatment ◽  
Cmv Infection ◽  
Rare Presentation ◽  
Intravenous Ganciclovir ◽  
Increased Risk ◽  
Oral Valganciclovir

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

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