Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

Abstract

In recent years, cytomegalovirus (CMV) has been recognized as an important common pathogen in immunocompromized patients. This is due to the increasing number of immunosuppressive medications, intensive cancer chemotherapy use, recurrent transplantations, progressively aging population, and the higher number of human immunodeficiency virus infections. Cytomegalovirus infection especially interests the gastrointestinal tract, anywhere, from the mouth to the anus. Namely, the most commonly affected area is the colon, followed by duodenum, stomach, esophagus and small intestine. The most frequent manifestations of CMV colitis are: diarrhea, fever, gastrointestinal bleeding and abdominal pain. We report here the case of an 82-year-old woman, who was treated for non-Hodgkin lymphoma; she was admitted to the emergency department for abdominal pain and diffuse arthralgia, following massive upper- and lower- gastrointestinal bleeding, due to duodenal and colonic ulcers related to CMV infection.

Hyperthrombotic Milieu in COVID-19 Patients

“…Viruses including Ebola, Marburg, Dengue, Huaiyangshan virus and Crimean-Congo hemorrhagic fever (CCHF) give rise to hemorrhagic fever in the host via multiple mechanisms, including cytokine-mediated endothelial activation and damage, clotting factor consumption and direct hepatic toxicity causing decreased production of clotting factors [42]. Hemorrhagic complications have rarely been noted in infections with non-hemorrhagic viruses such as varicella zoster virus (VZV) [42][43][44][45], cytomegalovirus (CMV) [46][47][48] and Epstein-Barr virus (EBV) [49]. On the other end of the spectrum, thrombotic complications including deep vein thrombosis (DVT), pulmonary embolism (PE), thrombotic microangiopathy (TMA), thrombotic thrombocytopenic purpura (TTP) and portal vein thrombosis have been reported in many viral infections including Avian influenza (H5N1), Swine flu (H1N1), Parvovirus B19, CMV, EBV, VZV, Hepatitis A and Hepatitis C virus and human immunodeficiency virus (HIV) [50].…”

Pancreas‐preserving duodenectomy after living donor liver transplantation for invasive cytomegalovirus disease

“…In our case, even pre‐operative duodenal biopsies were negative for CMV invasion. One possible explanation is that CMV had deeply infiltrated the duodenum and was therefore not detectable by superficial biopsies . This argument is supported by the histopathological findings of the surgical specimen, which demonstrated CMV infiltration in endothelial cells.…”