A Systemic and Severe Infection via Cytomegalovirus and Other Herpesviruses in a Young Apparently Immunocompetent Patient: A Case Report

Abstract

The members of human Herpesviridae family are fully acknowledged as pathogenic agents in immunocompromised individuals, often responsible for a number of severe diseases. On the other hand, in immunocompetent hosts, Herpesviridae-related infections typically display an asymptomatic or paucisymptomatic course, sometimes manifesting with flu-like symptoms. However, such infections can occasionally cause organ damage or multisystemic involvement in healthy subjects. Herein, we describe the first case of a simultaneous co-infection by five different Herpesviridae family members in an apparently immunocompetent young subject. A 30-year-old Caucasian man presented to our medical unit with colitis. During hospitalization, he developed multi-organ damage involving heart, pancreas and liver. Quantitative polymerase chain reaction analysis showed positive results for cytomegalovirus, Epstein-Barr virus, human herpes virus 6, human herpes virus 7, and human herpes virus 8. Remission of clinical manifestations and complete negativization of viral load were achieved by antiviral therapy. To the best of our knowledge, such simultaneous infection by multiple herpesviruses causing a severe multi-organ dysfunction has never been described in patients with preserved immune function. Careful literature review showed that organ damage in immunocompetent subjects was reported in very few cases of co-infection by two herpesviruses, and in only one case of co-infection by three herpesviruses. Multi-organ damage in our patient likely resulted from additional effects induced by Epstein-Barr virus, human herpes virus 6, human herpes virus 7, and human herpes virus 8, through either a superinfection occurring after initial cytomegalovirus disease, or a simultaneous co-infection of the different viral agents. Moreover, the possibility of a transient and partial immune dysfunction, predisposing the patient to develop a severe herpesvirus-associated disease, cannot be completely ruled out. Although a formal indication to antiviral therapy has not been established in herpesvirus-infected immunocompetent individuals, our case supports the usefulness of such therapy in case of severe multisystemic clinical manifestations. This original case report suggests that the possibility of multiple herpesvirus simultaneous infections should be taken into account in differential diagnosis for severe organ dysfunction, also in apparently immunocompetent subjects.

Herpesvirus surveillance and discovery in zoo-housed ruminants

“…infection of an individual host with multiple HVs has been documented previously [9,[54][55][56]; therefore, it was not surprising to identify multiple HVs within a single host species or individual animal from our sample population, especially given that many of the species had not been previously screened for HVs. Seventeen of the 44 GHVs were identified in more than one species (S2 Table ), with four GHVs observed in host species across both families Cervidae and Bovidae.…”

Timing of Treatment for Cytomegalovirus Infection in an Immunocompetent Middle-Aged Woman With Fulminant Ulcerative Colitis: A Case Report

“…CMV can cause chronic inflammation of the intestinal mucosa [ 4 ]. Chronic inflammation caused by CMV may inhibit the regeneration of the colonic mucosa, especially in patients with inflammatory bowel disease [ 5 ]. Some studies have suggested that CMV may play a role in the development or progression of UC [ 5 , 6 ]; however, the relationship between the two still needs to be clarified, especially in immunocompetent patients, such as younger patients not taking immunosuppressants.…”

Co-infection of Cytomegalovirus and Epstein-Barr Virus in an Immunocompetent Patient: A Case Series and Literature Review

“…The self-limiting course of infection typically includes malaise, protracted fever, mild liver-function abnormalities, and lymphocytosis with atypical lymphocytes that occur in ~ 10% of immunocompetent adults [1]. Rarely, immunocompetent patients may develop a severe infection that manifests with multiple organ involvement, co-infection with other viruses could be the explanation for severe and multi-systemic infections [2]. The simultaneous infection by multiple herpesviruses is extremely rare, and because of this, there are limited existing cases published in the literature.…”