Immunostaining Detection of Cytomegalovirus in Gastrointestinal Biopsies: Clinicopathological Correlation at a Large Academic Health System

Liao, Xiaoyan; Reed, Sharon L.; Lin, Grace

doi:10.14740/gr725e

Cited by 22 publications

(23 citation statements)

References 28 publications

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“…Studies that fail to demonstrate an effect of CMV infection on IBD outcomes may be accounted for by variances in the CMV burden, where reactivations associated with lower CMV burden are less likely to result in clinically significant CMV-driven disease [ 59 , 68 ]. Since CMV infection in patients with IBD is associated with rare IHC staining in approximately 50% of histologic specimen, most cases of CMV in gastrointestinal tissue are likely reactivation due to local immune dysregulation that has no or minimal clinical consequences [ 43 , 65 , 78 ].…”

Section: CMV In Ibd: Presentation Diagnosis and Managementmentioning

confidence: 99%

A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology

Fakhreddine

Frenette

Konijeti

2019

Gastroenterology Research and Practice

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Human cytomegalovirus (CMV) is a ubiquitous Herpesviridae virus with a wide spectrum of pathology in humans. Host immunity is a major determinant of the clinical manifestation of CMV and can vary widely in the gastroenterology and hepatology practice setting. Immunocompetent patients generally develop a benign, self-limited mononucleosis-like syndrome whereas gastrointestinal tissue-invasive disease is more frequently seen in immunocompromised and inflammatory bowel disease patients. Additionally, liver allograft dysfunction is a significant consequence of CMV infection in liver transplant patients. While polymerase chain reaction and immunohistochemistry techniques allow for the reliable and accurate detection of CMV in the human host, the diagnostic value of different serologic, endoscopic, and histologic tests depends on a variety of factors. Similarly, latent CMV, CMV infection, and CMV disease carry different significance depending on the patient population, and the decision to initiate antiviral therapy can be complex and patient-specific. This review will focus on the pathophysiology, diagnosis, and management of CMV in patient populations relevant to the practice of gastroenterology and hepatology—liver transplant recipients, inflammatory bowel disease patients, and otherwise immunocompetent patients.

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Section: CMV In Ibd: Presentation Diagnosis and Managementmentioning

confidence: 99%

A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology

Fakhreddine

Frenette

Konijeti

2019

Gastroenterology Research and Practice

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“…HCMV infection of the epithelial, endothelial, myocytes and fibroblast cells could result in both tissue destruction and formation of ulcers [26]. The prevalence of HCMV in gastric biopsy samples was reported to be 1% in studies conducted in India and the United States [27,28]. In our study, the incidence of CMV infection of the GI tract was as high as 5.1%.…”

Section: Discussionmentioning

confidence: 43%

Characterization of Gastrointestinal Human Cytomegalovirus Infection in Biopsy Samples from Urease Positive Patients

Pourmomen

Mohebbi

Bagheri

et al. 2018

jcbr

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Introduction: Human cytomegalovirus (CMV) is a ubiquitous organism that can infect multiple organs but rarely causes gastrointestinal (GI) symptoms. However, it can be reactivated in the GI tract and lead to gastric cancer. Here, we investigated CMV infection in patients with gastric complaints. Material and methods: In this study, 99 biopsy samples were collected from patients with GI symptoms and CMV genome was detected by polymerase chain reaction. Sequencing was performed for computational genotyping. Results: We observed that 88.99% of the samples were urease positive and 5.99% of the samples were CMV positive. Moreover, genotype of the samples belonged to group 4 (gB4). There was a relatively high incidence of CMV infection in patients with GI problems. Conclusions: Although symptomatic CMVassociated diseases of the GI tract are rare in immunocompetent individuals, they might be considered as potential complications of CMV infection.

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“…CMV inclusions can be identified on a routine HE staining, and IHC is available to identify CMV in the tissue ( 23 ). Interestingly, when cells are stained positive, serum CMV viral loads could be positive or negative ( 24 ). This patient's serum viral load was negative; however, CMV was detected on both, the routine HE staining ( Figure 3a ) and IHC ( Figure 3b ) of a mucosal tissue specimen from the edge of the patient's rectal ulcer.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Infection in an Adult Patient With Neuromyelitis Optica and Acute Hemorrhagic Rectal Ulcer: Case Report and Literature Review

et al. 2020

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Background: Previous infectious or inflammatory events may be involved in the pathogenesis of neuromyelitis optica (NMO), potentially by triggering an autoimmune response. Cytomegalovirus (CMV)-related NMO (CMV-NMO) is rarely reported. Acute hemorrhagic rectal ulcer (AHRU) is a rare disease with a largely unknown pathogenesis. Herein, we reported a co-NMO and AHRU case associated with CMV infection. In addition, we review previously reported cases of CMV-NMO and CMV-AHRU. Case presentation: A 40-year-old female diagnosed with aquaporin4 (AQP4)-IgG + NMO and a poor response to high-dose intravenous methylprednisolone and immunoglobulin, followed by three rounds of plasma exchange was transferred to Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. She developed repeated acute lower gastrointestinal hemorrhage from the third day of admission. Abdominal computed tomography angiography (CTA) and interventional angiography did not detect any bleeding vessel. Bedside colonoscopy revealed a large ulcer-like lesion at 10 cm above the anus. Rectal biopsy pathology confirmed a CMV infection on day 23 post-admission, and cerebrospinal fluid (CSF) pathogen gene sequencing detected CMV gene copies on day 25 post-admission. After 2 weeks of treatment with ganciclovir and sodium phosphinate, the patient's lower gastrointestinal bleeding stopped, and her limb muscle strength and visual acuity gradually improved. After 4 weeks of antiviral therapy, colonoscopy showed that the intestinal wall of the original lesion was smooth. Hematoxylin and eosin (HE) staining and immunohistochemistry (IHC) of a biopsy specimen was negative for CMV, her right eye vision was normal, and limb muscle strength had recovered. Serum AQP4-IgG was negative, and lesions on brain magnetic resonance imaging (MRI) manifested shrinkage. Conclusions: The benefits of antiviral therapy remain unclear; however, clinicians should be aware of the possibility of CMV-related NMO, if NMO was refractory to high-dose intravenous methylprednisolone, immunoglobulin, and plasma exchange. Moreover, clinicians should consider the possibility of CMV-related AHRU when recurrent acute lower gastrointestinal bleeding occurs in a patient.

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Immunostaining Detection of Cytomegalovirus in Gastrointestinal Biopsies: Clinicopathological Correlation at a Large Academic Health System

Cited by 22 publications

References 28 publications

A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology

A Practical Review of Cytomegalovirus in Gastroenterology and Hepatology

Characterization of Gastrointestinal Human Cytomegalovirus Infection in Biopsy Samples from Urease Positive Patients

Cytomegalovirus Infection in an Adult Patient With Neuromyelitis Optica and Acute Hemorrhagic Rectal Ulcer: Case Report and Literature Review

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