Cecum ulcer is a reliable endoscopic finding in cytomegalovirus colitis concomitant with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

Abstract

Although graft-versus-host disease (GVHD) is the major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), cytomegalovirus (CMV) reactivation also occurs in patients after allo-HSCT and these conditions often clinically overlap. The aim of this study was to determine reliable endoscopic findings of CMV colitis in patients with gastrointestinal graft-versus-host-disease (GI-GVHD). Patients after allo-HSCT who were histologically confirmed to have GI-GVHD with or without CMV colitis and patients with an immunosuppressive condition were retrospectively analyzed. We divided the patients into three groups: GI-GVHD with CMV colitis (group A), GI-GVHD without CMV colitis (group B), and CMV colitis without undergoing allo-HSCT (group C). From medical records, the involved colorectal areas and endoscopic findings according to the groups were compared. A total of 70 patients were divided into three groups (group A: n = 19, group B: n = 28, group C: n = 23). Mucosal injuries in groups A and C frequently occurred in the cecum including ileocecal valves. On the other hand, there were no abnormal lesions on ileocecal valves in group B. Furthermore, ulcer lesions were more frequently observed in groups A and C than in group B (p < 0.001). The sensitivity and specificity of mucosal injuries in the cecum for prediction of CMV colitis were 89.5 and 76.5%, respectively, and mucosal injuries in the cecum were more reliable findings than CMV antigenemia. Ulcer lesions in the cecum are reliable endoscopic findings for CMV colitis in patients with GI-GVHD after allo-HSCT.

Acute abdomen in the immunocompromised patient: WSES, SIS-E, WSIS, AAST, and GAIS guidelines

“…At the endoscopy, the only factor that may suggest the diagnosis is the presence of ulcerations with a well-defined, punched-out appearance present in up to 80% of patients [ 30 – 32 ]. Some studies proposed a typical cecum ulcer involving the ileocecal valve as a specific finding in CMV colitis in patients with graft-versus-host disease [ 33 ]. A biopsy is always required when colonoscopy is performed in IP, specifically considering CMV infection.…”

Pathophysiology of acute graft-versus-host disease from the perspective of hemodynamics determined by dielectric analysis

“…In some cases, the main causes of coagulation disturbances stem from treatment with anticancer drugs, radiation, or vascular endothelial damage caused by calcineurin inhibitors, which are used as immunosuppressants to prevent GVHD[ 1 , 5 , 6 ]. Furthermore, cytomegalovirus infection/reactivation induced in an immunodeficient state may also be involved in the aforementioned disturbances[ 7 , 8 ]. Additionally, clinically determining whether coagulation abnormalities and vascular endothelial disorders that develop after HSCT are caused by GVHD is often difficult[ 9 , 10 ].…”

S2489 Differentiating CMV Colitis From GVHD in Post-Transplant Patients: A Case Study

“…Endoscopy can identify cecal ulcers, a reliable finding for CMV colitis in patients with GVHD after allo-HSCT. 1 It is important to timely identify CMV colitis to prevent posttransplant morbidity and mortality. This case also demonstrates effectiveness of maribavir, a novel antiviral, for refractory post-transplant CMV colitis.…”