Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review

Abstract

Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

Cytomegalovirus and Epstein-Barr Infections: Prevalence and Impact on Patients with Hematological Diseases

“…CMV or EBV primary infection is usually asymptomatic in adults and children. In immunocompromised individuals, acute CMV infection may cause oral ulcers, periodontitis, sialadenitis, gingival hyperplasia, esophagitis, black esophagus, hepatitis, pancreatitis, gastritis, appendicitis, and among other clinical manifestations [ 34 , 35 ]. In immunocompetent individuals, the usual clinical symptoms include pharyngitis, lymphadenopathy, fever, and mononucleosis-like syndrome [ 36 ].…”

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

“…This is the first known case report of life-threatening hemorrhage from CMV duodenitis managed successfully with surgery. Among the four CMV duodenitis case reports found during literature review, three manifested with life-threatening bleeding, only one patient survived [7], [8], [9], [10]. In the surviving case, CMV was identified emergently on histopathologic examination of endoscopic biopsy [9].…”

“…A 2011 study of CMV infection in the upper GI tract, found the stomach to be the most common site of involvement and only one out of thirty cases involved the duodenum [6] . Literature review identified four case reports of CMV duodenitis [7] , [8] , [9] , [10] , where all four cases involved immunocompromised patients. Presented here is an atypical case of CMV duodenitis causing life-threatening hemorrhage in an immunocompetent individual, with no history of immunosuppressive treatments or infections.…”

“…CMV is difficult to identify based on endoscopic appearance alone because presentations are nonspecific. Primary findings include ulcerations, erosions, and mucosal hemorrhage [8] . The diagnostic gold standard for CMV infection is histopathological examination of endoscopic biopsy or surgical specimen.…”

Gastric Perforation in a 60-Year-Old Woman with CMV Gastritis and Amphetamine Abuse Led to Death

“…This infection is transmitted during birth, breastfeeding, sexual contact, organ transplant, or transfusion. This viral disease is prevalent in adults by involving 50-80% of the general population, representing an antibody to CMV by the age of 35 years [8].…”