Cytomegalovirus Infection in Immunocompetent Patients

Wreghitt, T.G.; Teare, E.L.; Sule, Olajumoke; Devi, Rema; Rice, Philip

doi:10.1086/379711

Cited by 151 publications

(95 citation statements)

References 17 publications

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“…There is now growing evidence of CMV infection in immunocompetent patients (3)(4)(5). Here, we present a case of CMV esophagitis in an immunocompetent patient, who presented with severe progressive chest pain and dysphagia after severe post-operative ileus (POI).…”

Section: Introductionmentioning

confidence: 98%

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Lim

Lee²,

Jin³

et al. 2014

Turk J Gastroenterol

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Cytomegalovirus (CMV) esophagitis is well-documented in immunocompromised patients. A few studies have described CMV infection in immunocompetent patients diagnosed with a critical illness. However, CMV esophagitis has rarely been documented in immunocompetent hosts. We report a case of CMV esophagitis in an immunocompetent patient who presented with chest pain and dysphagia that was successfully resolved with ganciclovir treatment. Our case supports observations that CMV esophagitis can cause significant morbidity, regardless of immune system status. Keywords: Cytomegalovirus, esophagus, immunocompetent INTRODUCTION Cytomegalovirus (CMV) is a type of herpesvirus and a common viral pathogen in humans. CMV causes various diseases, such as retinitis, hepatitis, encephalitis, pneumonia, and gastrointestinal infection in immunocompromised patients (1,2). CMV-associated gastrointestinal infection has been reported to mainly invade the colon and stomach, but it may also occur in other organs (2).CMV-associated gastrointestinal infections are generally resolved without clinical symptoms in immunocompetent patients, but the infection can be fatal in the immunocompromised (3).There is now growing evidence of CMV infection in immunocompetent patients (3-5). Here, we present a case of CMV esophagitis in an immunocompetent patient, who presented with severe progressive chest pain and dysphagia after severe post-operative ileus (POI). The patient was successfully treated with ganciclovir. This positive outcome has been added to an updated review of the literature regarding CMV esophagitis in immunocompetent hosts. CASE PRESENTATIONA 67-year-old male patient was referred to the gastroenterology department following 3 days of progressive chest pain and dysphagia. The chest pain was localized to the retrosternum and was aggravated by eating. His dysphagia was localized to the retrosternum and neck with associated odynophagia. Ten days before the attack of chest pain and dysphagia, the patient has undergone surgery for a burst fracture of the 12 th thoracic vertebra and left orbital bone fracture caused by a traffic accident. Two days after surgery, he developed abdominal distension, nausea and vomiting. He continued to vomit, and subsequently developed aspiration pneumonitis. He was managed medically for aspiration pneumonitis and POI, and his symptoms subsequently improved.At time of referral, the patient's vital signs were stable with blood pressure, 130/80 mmHg; heart rate, 72 beats/ min; respiration rate, 18/min; and body temperature, 37°C. The physical examination revealed a chronically ill-looking man with mild epigastric tenderness. The complete blood count showed leukocytes, 8,200/μL; hemoglobin, 9.8 g/dL; and platelet count, 414,000/μL. Blood chemistry showed sodium, 137 mmol/L; potassium, 3.5 mmol/L; chloride, 101 mmol/L; aspartate aminotransferase/alanine aminotransferase, 58/34 IU/L; blood urea nitrogen, 14 mg/dL; creatinine, 0.44 mg/dL; albumin, 3.1 g/dL; and C-reactive protein, 6.08 mg/dL. Case ReportTurk ...

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Section: Introductionmentioning

confidence: 98%

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Lim

Lee²,

Jin³

et al. 2014

Turk J Gastroenterol

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“…Symptomatic CMV infections in immunocompetent patients usually occur in younger age groups and are rare in the elderly [15]. The diagnosis of primary CMV infection in this 70 year-old patient was based on serologic findings showing seroconversion and a high titer of CMV IgM antibodies of intermediate avidity.…”

Section: Discussionmentioning

confidence: 88%

“…CMV was also isolated from BAL fluid suggesting CMV pneumonia. However, a positive BAL finding for CMV is common in patients with multiple opportunistic pulmonary infections, including Pneumocystis jiroveci infection, and cannot generally be equated to CMV pneumonia [15]. A study of asymptomatic HIV-infected subjects showed that BAL cultures were positive for CMV in nine out of 19 subjects irrespective of their pulmonary symptoms [16].…”

Section: Discussionmentioning

confidence: 99%

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Primary cytomegalovirus infection with accompanying Pneumocystis jiroveci pneumonia in a patient with large-vessel vasculitis

2010

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A 70 year-old female patient presented with fever, nausea and dyspnea. She had been receiving immunosuppressive therapy with methotrexate and prednisone for large-vessel vasculitis. The patient was shown to have coexistent Pneumocystis jiroveci pneumonia and primary cytomegalovirus (CMV) infection with presumed CMV pneumonitis and colitis. To our knowledge, this is the first case report on the occurrence of combined primary cytomegalovirus and Pneumocystis jiroveci infection in a patient with vasculitis. It illustrates the importance of being aware of the possibility of combined opportunistic infections in patients with rheumatologic diseases.

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“…1 Severe complications, such as venous thrombosis, have been rarely reported although they may be underestimated. 2 In this regard, a recent prospective study has suggested that acute CMV infection may be associated with an increased short-term risk of venous thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

et al. 2015

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We describe a 39-year-old male who presented with a fever of unknown origin, the diagnostic work-up of which disclosed an acute cytomegalovirus (CMV) infection complicated by a partial superior mesenteric vein (SMV) thrombosis. Further investigations revealed the presence of factor V Leiden mutation. Oral anticoagulant treatment with warfarin led to a complete recanalization of SMV two months after. A literature review on the association between CMV infection and portal system (PS) thrombosis in immunocompetent patients was performed. We found that, in agreement with our case, in a minority of case reports patients did not complain of abdominal pain, but presented with a mononucleosis-like syndrome with malaise and prolonged fever and displayed a variable elevation of aminotransferase levels. Interestingly, most of them exhibited a limited extension of portal thrombosis. On the whole, these data suggest that PS thrombosis during acute CMV infection may be an underestimated complication.

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Cytomegalovirus Infection in Immunocompetent Patients

Cited by 151 publications

References 17 publications

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Primary cytomegalovirus infection with accompanying Pneumocystis jiroveci pneumonia in a patient with large-vessel vasculitis

Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

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