Cytomegalovirus duodenitis associated with life-threatening duodenal hemorrhage in an immunocompetent patient: A case report

Shen, Lucy Q.; Youssef, David; Abu-Abed, Suzan; Malhotra, Sangita; Atkinson, Kenneth G.; Vikis, Elena; Melich, George; MacKenzie, Shawn

doi:10.1016/j.ijscr.2017.02.029

Cited by 38 publications

(5 citation statements)

References 16 publications

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“…CMV seroprevalence can vary from 40 to 100% in the adult population depending on age, different geographic regions and economic status [14]. it's not uncommon to have GI CMV disease without postive CMV antibodies and viremia [13]. We found Only 20% of patients with CMV colitis had CMV-specific IgG antibody in their serum, which may be due to the impaired humoral response to CMV in these AIDS patients.…”

Section: Discussionmentioning

confidence: 68%

“…Serological methods indirectly provide evidence of CMV infection by detection of antibodies in serum. However, Serologic detection of CMV IgM and IgG are not often helpful in identifying active disease but may determine current or prior exposure [13]. CMV seroprevalence can vary from 40 to 100% in the adult population depending on age, different geographic regions and economic status [14].…”

Section: Discussionmentioning

confidence: 99%

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Programmed death-1 expression and regulatory T cells increase in the Intestinal mucosa of cytomegalovirus colitis in patients with HIV/AIDS

et al. 2020

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Background: Cytomegalovirus (CMV) is among the most common opportunistic infections identified in patients with HIV/AIDS. CMV often targets the colon in such patients. However, the role of regulatory T cells (T regs) and Programmed death-1 (PD-1) in intestinal CMV infection is unclear. In this study, we evaluate the expression of programmed death-1 (PD-1) and its association with regulatory T cells (T regs) in patients with HIV/AIDS having CMV colitis. Methods: CMV was detected in the intestinal mucosal biopsy samples via nucleic acid in situ hybridization. PD-1, CD4, CD8, and T reg-specific marker as well as the winged-helix transcription factor and forkhead box P3 (FoxP3) were detected by immunohistochemical methods. Results: Intestinal CMV diease was identified in 20 out of 195 patients with HIV/AIDS enrolled in our study. CMV was diagnosed microscopically by the presence of giant cell inclusion bodies in epithelial cells, histiocytes, and fibroblasts. Levels of immunoreactive PD-1 detected in mucosal biopsies from patients with HIV/AIDS having CMV colitis were significantly higher than CMV-negative control group (p = 0.023). FoxP3 + cells were detected in the CMV colitis group slight more than that in the control group. CD4 + T lymphocyte counts in the peripheral blood and intestinal mucosal biopsies from CMV colitis group were all notably decreased compared with those with control group (p < 0.001 for both). PD-1 had a significant negative correlation with CD4 counts in intestinal mucosa (p = 0.016). CD8 + T lymphocyte counts in peripheral blood and intestinal mucosa were slightly lower than those in the control group, although the differences were not statistically significant. Conclusions: CMV colitis with HIV/AIDS is associated with significant changes in T lymphocyte populations. These findings may have important implications for disease pathogenesis and progression.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Programmed death-1 expression and regulatory T cells increase in the Intestinal mucosa of cytomegalovirus colitis in patients with HIV/AIDS

et al. 2020

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“…However, identifying CMV based solely on endoscopic appearance is di cult due to nonspeci c presentations. Primary ndings typically include ulcerations, erosions, and mucosal hemorrhage [7,9,11]. According to the guideline [3], the diagnosis of CMV end-organ disease is typically based on the clinical presentation and detection of the virus in tissue.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening gastrointestinal bleeding caused by cytomegalovirus-induced duodenal ulcer in a patient with AIDS： a case report

Song,

Guo,

Zou

et al. 2023

Preprint

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Background Diagnosis and treatment for gastrointestinal bleeding among patients with acquired immune deficiency syndrome (AIDS) were challenging. Here we present a rare case of life-threatening gastrointestinal bleeding in an AIDS patient. Case presentation A 31-year-old male with a three-month history of HIV infection was admitted on July 18, 2023, complaining of abdominal pain for over one month and hematochezia for the past twelve days. During his hospitalization, gastrointestinal endoscopy identified the source of bleeding as a duodenal ulcer associated with cytomegalovirus(CMV) infection confirmed through comprehensive determination methods involving metagenomic next-generation sequencing (mNGs), hematoxylin-eosin(HE), and immunohistochemistry (IHC) staining of biopsy tissue from the ulcer. The patient received interventional embolization to manage emergency gastrointestinal bleeding in addition to four-week anti-CMV treatment and remained in stable clinical condition during two months follow-up. Conclusions This case highlights potential complexity of CMV infection in HIV-infected patients with gastrointestinal bleeding.

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“…Several methods, including viral culture, serological tests, polymerase chain reaction (PCR), and shell viral assay, are proposed to diagnose GI CMV infection. However, virologic and serologic tests may be restricted in diagnosing the GI-restricted CMV disorder [ 12 ]. The primary process for diagnosis is endoscopy for identifying mucosal lesion, as well as tissue biopsy to confirm the infection.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus cell tropism and clinicopathological characteristics in gastrointestinal tract of patients with HIV/AIDS

et al. 2022

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Background Cytomegalovirus (CMV) has been recognized as one of the frequently occurring opportunistic infections (OIs) reported in the patients having human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In addition, it has been identified as the factor leading to gastrointestinal (GI) tract disorder among HIV/AIDS population. CMV exhibits broad cell tropism in different organs. This study evaluated the CMV cell tropism and clinicopathological characteristics of CMV infection in the different GI regions in HIV/AIDS cases. Methods Using nucleic acid in situ hybridization (ISH), CMV was detected in the gastrointestinal mucosal biopsy samples. The paraffin-embedded samples were stained with hematoxylin and eosin (HE) and immunohistochemistry (IHC), respectively. Results A total of 32 HIV/AIDS patients were enrolled in this study. Fourteen of these patients underwent gastroscopy, while the remaining eighteen received colonoscopy. CMV-infected cells were observed at 46 GI sites. Among them, the colon was the region with the highest susceptibility to GI CMV infection (n = 12, 26.1%). The CMV giant cell inclusion bodies were detected in epithelial cells and mesenchymal cells, including histiocytes, smooth muscle cells, fibroblasts, and endothelial cells. In the duodenum, there were markedly more positive epithelial cells than mesenchymal cells (p = 0.033). In contrast, in the esophagus (p = 0.030), cardia (p = 0.003), rectum (p = 0.019), colon (p < 0.001), and cecum (p < 0.001), there were notably less positive epithelial cells than mesenchymal cells. The expression levels of PDGFRα and Nrp2 in the mesenchymal cells were higher than the epithelial cells in cardia, cecum, colon, sigmoid, and rectum, especially in the areas with ulcers. However, Nrp2 in the epithelial cells was higher than that in the duodenum. Moreover, the positive CMV DNA in peripheral blood was related to the CMV-positive cell count, as well as the ulceration in GI tract (p = 0.035 and 0.036, respectively). Conclusions The colon has been identified as the GI site with the highest susceptibility to CMV infection. There are different CMV-infected cells in the different sites of the GI that relate to the expression level of PDGFRα and Nrp2. CMV DNA positive in the blood is related to the positive CMV cell count, as well as ulceration in the GI tract.

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Cytomegalovirus duodenitis associated with life-threatening duodenal hemorrhage in an immunocompetent patient: A case report

Cited by 38 publications

References 16 publications

Programmed death-1 expression and regulatory T cells increase in the Intestinal mucosa of cytomegalovirus colitis in patients with HIV/AIDS

Programmed death-1 expression and regulatory T cells increase in the Intestinal mucosa of cytomegalovirus colitis in patients with HIV/AIDS

Life-threatening gastrointestinal bleeding caused by cytomegalovirus-induced duodenal ulcer in a patient with AIDS： a case report

Cytomegalovirus cell tropism and clinicopathological characteristics in gastrointestinal tract of patients with HIV/AIDS

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