Abstract
with primary or acquired immune deficiency. CMV colitis may present with clinic symptoms such as abdominal pain, diarrhea, hematochezia, melena and fever. Stricture due to CMV colitis is a very rare complication. We discuss ileum and colon stricture due to CMV colitis in an immunodeficient patient in this paper.
The two-year-old male patient was being followed-up with combined immunodeficiency and the bare lymphocyte syndrome. He was hospitalized at the pediatric intensive care unit for diarrhea and pneumonia for the last month. CMV PCR was positive in the tests and ganciclovir was therefore added to the treatment. Colonoscopy was performed for fecal occult blood by the pediatric gastroenterology unit. The biopsy result was reported as CMV colitis.
The patient developed ileus during follow-up, and the colon graph with contrast revealed a narrow colon segment with the contrast agent unable to pass to the terminal ileum. Laparotomy was performed and strictures observed in the terminal ileum and the ascending colon. An ileocolic anastomosis was performed by resecting the bowel loops affected by stricture. The histomorphologic findings were reported as CMV colitis. The patient was discharged and referred for follow-up to the pediatric service.
Cytomegalovirus is an opportunistic virus that can lead to the infection of the gastrointestinal system in individuals with immunodeficiency. CMV colitis and stricture should be considered in the differential diagnosis in immunodeficient children with ileus symptoms.
References
- 1. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: A systematic review. Virol J 2008;5:47.
- 2. Şahin S, Özhamam E, Kulaçoğlu S, Seçkin S. Life-threatening cytomegalovirus colitis in an immunocompetent patient: A case report. Bozok Tıp Dergisi 2013;3:72-6.
- 3. Jonkhoff-Slok TW, Veenhoven RH, de Graeff-Meeder ER, Büller HA. An immunocompetent infant with cow’s milk allergy and cytomegalovirus colitis. Eur J Pediatr 1997;156: 528-9.
- 4. Hinds R, Brueton MJ, Francis N, Fell JM. Another cause of bloody diarrhoea in infancy: Cytomegalovirus colitis in an immunocompetent child. J Paediatr Child Health 2004;40:581-2.
- 5. Abdulhannan P, Sugarman ID, Wood P, Puntis JW. Primary CMV colitis in an immunocompetent infant, successfully treated by gancyclovir. J Pediatr Gastroenterol Nutr 2008;47:203-5.
- 6. Hadaya K, Kaiser L, Rubbia-Brandt L, Gervaix A, Diana A. Ganciclovir for severe cytomegalovirus primary infection in an immunocompetent child. Eur J Clin Microbiol Infect Dis 2004;23:218-20.
- 7. Ekema G, Pedersini P, Milianti S, Ubertazzi M, Minoli D, Manciana A. Colonic stricture mimicking Hirschsprung’s disease: A localized cytomegalovirus infection. J Pediatr Surg 2006;41:850–2.
- 8. Shetty A, Barnes R, Lazda E, Doherty C, Maxwell N. Cytomegalovirus: A cause of colonic stricture in a premature infant. J Infect 2007;54:e37–9.
- 9. Tzialla C, Decembrino L, Di Comite A, Bollani L, Colombo R, Stronati M. Colonic stricture and retinitis due to cytomegalovirus infection in an immunocompetent infant. Pediatr Int 2010;52:659– 60.
Abstract
Sitomegalovirüs (CMV) birincil veya edinsel immün yetmezliği olan kişilerde farklı organ sistemlerinin tutulumu ile ciddi klinik tablolara yol açabilir. CMV koliti karın ağrısı, diare, hematokezya, melena veya ateş gibi klinik semptomlar ile kendini gösterebilir. CMV kolitine bağlı striktür nadir bir komplikasyondur. Bu olgu sunumunda; ileus nedeni ile konsülte edilen, immün yetmezlikli bir hastadaki CMV kolitine bağlı ileum ve kolon striktürü paylaşılmıştır.
Bare Lenfosit Sendromu ile birlikte kombine immün yetmezlik tanısı nedeni ile takip edilen 2 yaşındaki erkek hasta, bir aydır süren ishal ve pnömoni nedeniyle pediatri yoğun bakım yatırıldı. Tetkiklerinde CMV PCR pozitif olması üzerine tedaviye gansiklovir eklendi. Gaitada gizli kan olması üzerine pediatrik gastroenteroloji tarafından kolonoskopi yapıldı. Alınan biyopsi sonucu CMV koliti olarak geldi. Takipte ileus gelişen hastanın kolon grafisinde çıkan kolon segmentinin dar olduğu ve kontrast maddenin terminal ileuma geçmediği görüldü. Laparatomi yapılan olguda terminal ileum ve çıkan kolonun striktüre olduğu görüldü. Striktüre bağırsak ansları rezeke edilerek ileokolik anastomoz yapıldı. Histomorfolojik bulgular CMV koliti olarak değerlendirildi. Hasta taburcu edilerek takibi için pediatriye yönlendirildi.
CMV, immün yetmezliği olan hastalarda gastrointestinal sistemde enfeksiyona yol açabilen fırsatçı bir virüstür. İmmün yetmezlikli çocuklarda ileus tablosuna yol açan nedenler arasında CMV koliti ve striktür ayırıcı tanıda düşünülmelidir.
References
- 1. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: A systematic review. Virol J 2008;5:47.
- 2. Şahin S, Özhamam E, Kulaçoğlu S, Seçkin S. Life-threatening cytomegalovirus colitis in an immunocompetent patient: A case report. Bozok Tıp Dergisi 2013;3:72-6.
- 3. Jonkhoff-Slok TW, Veenhoven RH, de Graeff-Meeder ER, Büller HA. An immunocompetent infant with cow’s milk allergy and cytomegalovirus colitis. Eur J Pediatr 1997;156: 528-9.
- 4. Hinds R, Brueton MJ, Francis N, Fell JM. Another cause of bloody diarrhoea in infancy: Cytomegalovirus colitis in an immunocompetent child. J Paediatr Child Health 2004;40:581-2.
- 5. Abdulhannan P, Sugarman ID, Wood P, Puntis JW. Primary CMV colitis in an immunocompetent infant, successfully treated by gancyclovir. J Pediatr Gastroenterol Nutr 2008;47:203-5.
- 6. Hadaya K, Kaiser L, Rubbia-Brandt L, Gervaix A, Diana A. Ganciclovir for severe cytomegalovirus primary infection in an immunocompetent child. Eur J Clin Microbiol Infect Dis 2004;23:218-20.
- 7. Ekema G, Pedersini P, Milianti S, Ubertazzi M, Minoli D, Manciana A. Colonic stricture mimicking Hirschsprung’s disease: A localized cytomegalovirus infection. J Pediatr Surg 2006;41:850–2.
- 8. Shetty A, Barnes R, Lazda E, Doherty C, Maxwell N. Cytomegalovirus: A cause of colonic stricture in a premature infant. J Infect 2007;54:e37–9.
- 9. Tzialla C, Decembrino L, Di Comite A, Bollani L, Colombo R, Stronati M. Colonic stricture and retinitis due to cytomegalovirus infection in an immunocompetent infant. Pediatr Int 2010;52:659– 60.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | CASE REPORTS |
| Authors | |
| Publication Date | March 21, 2019 |
| Submission Date | March 18, 2018 |
| Published in Issue | Year 2019 Volume: 13 Issue: 1 |
The publication language of Turkish Journal of Pediatric Disease is English.
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