Cytomegalovirus colitis in intensive care unit patients: Difficulties in clinical diagnosis

Chan, Khee Siang; Yang, Chengxu; Chen, Chin Ming; Yang, His Hsing; Lee, Ching Chien; Chuang, Yin Ching; Yu, Wen Liang

doi:10.1016/j.jcrc.2014.01.003

Cited by 25 publications

(23 citation statements)

References 24 publications

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“…With the exception of a prolonged ICU stay, our patient had none of the other above-mentioned factors. The main gastrointestinal manifestations of CMV colitis in ICU patients are intermittent bloody stool or massive lower gastrointestinal bleeding and refractory watery diarrhea (14). Thus the diagnosis of CMV colitis might be complicated as it may mimic the symptoms of other diseases.…”

Section: Discussionmentioning

confidence: 99%

“…The reported colonoscopic findings of CMV colitis include various lesions such as a solitary ulcer, multiple ulcers, ischemic colitis, polypoid lesions, and pseudomembranous colitis-associated lesions (8)(9)(10)(11)(12). When investigations into the etiology of acute hemorrhagic rectal ulcers are performed, physicians should exclude other diseases such as CMV colitis (13,14). The definitive diagnosis of CMV colitis is made based on the histological finding of inclusion bodies in enlarged cells of the mucosa and by CMV-specific immunohistochemical staining (6).…”

Section: Introductionmentioning

confidence: 99%

“…The definitive diagnosis of CMV colitis is made based on the histological finding of inclusion bodies in enlarged cells of the mucosa and by CMV-specific immunohistochemical staining (6). However, CMV immunohistochemical staining is not routinely performed for patients with mucosal ulcers in which there is no obvious evidence of inclusion bodies in large cells (14). Therefore, it is a great challenge for intensivists and physicians to diagnose CMV colitis in ICU patients in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

“…CMV colitis tends to occur in patients whose ICU stay is prolonged. This mostly includes patients with chronic kidney disease, end-stage renal disease, diabetes mellitus, or coronary artery disease (14). Therefore, CMV colitis is not necessarily limited to immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, CMV colitis is not necessarily limited to immunocompromised patients. The main gastrointestinal manifestations of CMV colitis in intensive care patients are intermittent bloody stool or massive lower gastrointestinal bleeding and refractory watery diarrhea (14). In a previous report, 2 of 18 such ICU patients died due to CMV colitis, while 10 patients died of underlying disorders that were not directly related to CMV colitis (14).…”

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

et al. 2016

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A 68-year-old man visited an emergency department complaining of dyspnea. He was diagnosed to have Legionella pneumonia with multiple organ failure. Although his multiple organ failure improved, he suffered from persistent abdominal pain and diarrhea with continuous minor bleeding. Colonoscopy revealed a longitudinal ulcer of the rectum, below the peritoneal reflection. He was diagnosed with cytomegalovirus (CMV) colitis. Antiviral therapy with ganciclovir was initiated. He finally underwent a colostomy after a bowel stricture caused an intestinal outlet obstruction, which made oral intake impossible. Based on the present case, we believe that CMV colitis must be considered as one of the differential diagnoses when critically ill patients develop continuous diarrhea and abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

et al. 2016

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Severe ulcerative esophagitis and colitis induced by crizotinib therapy: A case report

Hsu

2020

Adv in Digestive Medicine

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The expression of anaplastic lymphoma kinase (ALK), a target of tyrosine kinase is altered in several kinds of cancer, including in non‐small cell lung cancer (NSCLC). For this reason, the use of crizotinib to treat locally advanced or metastatic ALK‐positive NSCLC was approved by the US Food and Drug Administration in 2011. The reported adverse events during clinical trials with crizotinib included esophageal disorders in 11% of the patients, although none of them experienced severe events. Drug‐induced esophagitis or more severe ulcerations are considerably rare according to the available case reports. We report a patient who presented with severe esophageal ulcers after 2‐year treatment with crizotinib for metastatic, ALK‐positive NSCLC. These clinical conditions improved after education on proper eating habits and an additional prescription of a proton pump inhibitor. Several months later, the patient developed colitis with severe diarrhea, which was successfully controlled with mesalazine without reductions in the dosage of crizotinib. To the best of our knowledge, this is the first published case of successfully treated, consecutive esophageal and colonic ulcers related to crizotinib use. Crizotinib is a widely used targeted therapy for locally advanced or metastatic ALK‐positive NSCLC, and clinicians should keep in mind its severe drug‐related adverse effects such as esophagitis and colitis. Treatment with mesalazine, esomeprazole, and slightly decreasing the dose of crizotinib to 200 mg twice daily will be effective.

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Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression

Ong

Chong

Chemaly

et al. 2022

Clinical Microbiology and Infection

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Cytomegalovirus colitis in intensive care unit patients: Difficulties in clinical diagnosis

Cited by 25 publications

References 24 publications

Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

Severe ulcerative esophagitis and colitis induced by crizotinib therapy: A case report

Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression

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