Enterocolic fistula: A rare presentation of cytomegalovirus infection

In the present report, the first reported case of cytomegalovirus (CMV)-associated enterocolic fistula in an HIV/AIDS patient is described. CMV colitis is the second most common presentation of CMV infection in immunocompromised patients. CMV-associated enteric fistulae are an exceedingly rare complication, with only four previous cases described: a gastrocolic, an enterocutaneous, a rectovaginal and a colocutaneous fistula. Management of these patient demonstrates the importance of treating the precipitating viral infection before considering surgical intervention of the enterocolic fistula.     

Cytomegalovirus myeloradiculitis in pregnancy]

INTRODUCTION: Cytomegalovirus neurological complications are frequent in immunocompromised patients specially in HIV positive patient. In immunocompetent patient these complications are infrequent. EXEGESIS: We describe a case of cytomegalovirus myeloradiculitis during pregnancy in a 25-year-old woman, HIV negative. The evolution was favorable with foscarnet therapy. CONCLUSION: A spinal complication during cytomegalovirus infection in immunocompetent patient should lead to a therapy with a specific antiviral to reduce neurologic involvement.     

Lung neoplasms revealing a rare cutaneous tumor: eccrine porocarcinoma

INTRODUCTION: Eccrine sweat gland carcinoma, which belongs to the eccrine sweat gland carcinoma family, is a rare malignancy of the skin with a potential aggressive growth and metastatic spread. EXEGESIS: We report here a case of malignant eccrine poroma arising on the upper leg, with widespread pulmonary metastases. CONCLUSION: A brief synopsis of the pathological and clinical aspects of eccrine sweat gland carcinoma is presented with the currently available therapies.     

Catastrophic gastrointestinal complication of systemic immunosuppression

We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone.The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis.Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus(HSV)and cytomegalovirus(CMV)respectively.Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens.CMV on the other hand most commonly causes a colitis or less commonly oesophagitis.CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only.Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate.The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.     

Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient

Cholangitis and pancreatitis associated with cytomegalovirus (CMV) infection in an immunocompetent patient is reported. Endoscopic retrograde cholangiography performed on a 55-year-old man for evaluation of the cause of jaundice and liver dysfunction revealed a distal focal irregular narrowing of the common bile duct. Microscopic findings of the resected specimen showed chronic cholangitis and CMV pancreatitis. Immunohistochemistry disclosed that epithelial cells in the inflamed bile duct were positive for CMV antigen, which was compatible with CMV cholangitis. Inflammation of the biliary tract or pancreas by CMV has been commonly reported as a complication in immunocompromised patients. Our report appears to be a rare case, but suggests that CMV cholangitis or pancreatitis should be considered in the differential diagnoses of common bile duct stenosis or pancreatitis even in immunocompetent individuals.     

Cholestasis,ascites and pancytopenia in an immunocompetent adult with severe cytomegalovirus hepatitis

Human cytomegalovirus (CMV) is a herpesvirus, which establishes lifelong latency after primary infection and leads to severe disease in immunocompromised patients. However, CMV infection in immunocompetent patients is usually asymptomatic and severe organ damage is rarely reported. We report a case of severe CMV hepatitis in an immunocompetent patient presenting with cholestasis, portal hypertension-related ascites and pancytopenia. The patient was asymptomatic with normal liver function and negative CMV DNA after two weeks of antiviral therapy. This case is an example of a common infection with an uncommon presentation, and suggests that testing for CMV should be carried out, even in patients with normal immune status, presenting with severe liver damage or cholestasis.     

Eccrine poroma presented as spindle-shaped plaque: A case report

Rationale:Eccrine poroma, a benign cutaneous neoplasm originating from the intraepidermal portion of the eccrine sweat duct, is relatively common in clinical practice. Nevertheless, the 1 presenting as spindle-shaped plaque is extremely rare and easily misdiagnosed as seborrheic keratosis or other dermatoses. Thus, the current study demonstrates a case of eccrine poroma with unique clinical manifestation.Patients concerns:A 47-year-old man presented with a spindle-shaped plaque on his left sole for 6 years.Diagnoses:Based on the clinical and histopathological manifestations, diagnosis of eccrine poroma was established.Interventions:Surgical excision under local anesthesia was performed.Outcomes:No recurrence or malignant transformation occurred within 6-month follow-up.Lessons:Eccrine poroma typically presents as a dome-shaped nodule on palm or sole. But this case reminded us the lesion presenting as a spindle-shaped plaque on sole can not rule out the possibility of eccrine poroma.     

Ultrasonographic features of eccrine spiradenoma: A case report

Rationale:Eccrine spiradenoma (ES) is a rare benign skin adnexal tumor originating from eccrine sweat glands. The features of ES on ultrasonography (US) have received little attention. Therefore, we report the sonographic findings in a case of an ES that originated from the abdominal wall and discuss the previously reported cases.Patient concerns:A 53-year-old woman was admitted to our hospital with a complaint of a painful nodule on the right side of her abdominal wall of 1-year duration.Diagnoses:The mass on the right side of abdominal wall was diagnosed as ES by histopathological examination.Interventions:The patient subsequently underwent total excision of the mass.Outcomes:The patient recovered well and had no complications during the 1-year follow-up.Lessons:As eccrine spiradenoma (ES) is rare and most of the tumors are excised without prior imaging studies. Little is known regarding the features of ES on ultrasonography (US). Familiarizing with the clinical and US features of this rare tumor may increase awareness of the disease among sonographers and clinicians.     

Portal thrombosis complicating an acute cytomegalovirus infection in an immunocompetent patient

INTRODUCTION: The cytomegalovirus (CMV) infection is most often asymptomatic. The grave forms concern the immunocompromised patients. We report a new case pf acute CMV hepatitis complicated with portal thrombosis in an immunocompetent patient. EXEGESIS: A 29 year old man has presented a CMV hepatitis proved by the presence of pp65 protein and the viral DNA in serum. This infection was complicated by a portal thrombosis and the evolution was rapidly favourable under anticoagulant treatment. Eleven cases of major thrombosis complicating acute CMV infection in immunocompetent patients were previously reported in the English and French literature. The absence of local and general cause, the remission without anticoagulation, the elevated risk of thrombosis in both HIV and CMV seropositive patients, and in CMV seropositive renal transplant patients suggest a causal relation. Various pathogenic hypotheses were raised: presence of antiphospholipid antibodies, absent in our case, procoagulant phenotype induction of infected endothelial cells, proliferation induction of smooth cells. CONCLUSION: The acute CMV infection can be considered such as a possible cause of major thrombosis.     

Cytomegalovirus ischemic colitis: a near-fatal presentation of HIV infection

Cytomegalovirus infection occurs in immunocompromised patients. We present a 45-year-old male with no prior medical history who presented to the hospital with weight loss and non-bloody diarrhea. During hospitalization, he developed severe hematochezia and hypotension. Colonoscopy revealed dusky, friable mucosa. The patient arrested and was resuscitated. Specimen from emergent colectomy showed ischemic changes secondary to cytomegalovirus infection of endothelium and small-vessel thrombosis. An HIV test was subsequently positive with CD4 count of 2 per microliter. The patient was treated with antiretroviral therapy and ganciclovir. He survived postoperative infections and was eventually discharged. In summary, this case of near-fatal cytomegalovirus colitis represents an unusual presentation of undiagnosed HIV infection. Cytomegalovirus infection should be included in the differential diagnosis of immunocompromised patients with gastrointestinal symptoms. Hematochezia may be from intestinal ulceration or severe ischemic damage. Antiretroviral therapy and ganciclovir or foscarnet should be initiated promptly. Surgery is indicated in life-threatening hemorrhage or obvious bowel necrosis.     

Cytomegalovirus esophagitis in a patient on peritoneal dyalisis

Symptomatic cytomegalovirus (CMV) infection usually affects immunocompromised patients, such as transplant recipients. From that point of view, the patient with endstage renal disease under maintenance dialysis is considered as immunocompetent. Thus, opportunistic infections, such as CMV infection, is not systematicaly searched in these patients, despite that an impaired cellular immunity has been reported in dialysis patients. We report a case of CMV esophagitis, clinically symptomatic, in a patient endstage renal disease under peritoneal dialysis, without other known immunosuppressive factors and with a good clinical response to gancyclovir treatment.     

Intestinal Tuberculosis Presenting as Fever of Unknown Origin in a Heart Transplant Patient

Summary Patients undergoing transplantation have an increased risk of developing infections such as tuberculosis, Pneumocystis carnii pneumonia, Candida infections or cytomegalovirus infections because of their immunosuppressive therapy with cyclosprin A, azathioprine and steroids. Mycobacterial infection is well recognized as a complication in the immunocompromised host but diagnosis and therapy are very difficult. Received: September 23, 1998 · Revision accepted: February 14, 1999     

Severe Hemorrhage from Cytomegalovirus Rectal Ulcers in a Burned Adult

Clinically evident gastrointestinal involvement by cytomegalovirus has been amply documented in various immunocompromised states with the notable exception of burns. A 44-yr-old man, having sustained 40% burn, who developed severe bleeding from rectal ulcers at the time of a primary cytomegalovirus infection is described. Evidence is provided, implicating cytomegalovirus as the responsible pathogen. We suggest that cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal bleeding occurring in a burned patient. In that case, bleeding can occur from any part of the gastrointestinal tract.     

Pathogenicity of Eikenella corrodens in humans

Eikenella corrodens is resident flora of the normal adult human oral cavity. Four cases of verified infection and previous case reports of infections caused by this organism were reviewed and analyzed. Rarely has this bacillus been found as the sole isolate to initiate infection in the host with normal immune status. In the immunocompromised host, this organism was observed as the sole isolate in cases of persistent empyemas and/or overwhelming pneumonias with bacteremias. The potential of the organism singly to perpetuate an established infection appears real. In the immunocompromised patients such potentials are accentuated and can result in fulminant pulmonary infections and death. The finding of E corrodens in an infection site of a compromised patient should indicate specific therapy.     

Pulmonary involvement during cytomegalovirus infection in immunosuppressed patients

Abstract: Although cytomegalovirus (CMV) pulmonary involvement after solid organ transplantation is infrequently seen nowadays, CMV pneumonitis is still a potential lethal complication. Introduction of the pp65 antigenemia assay enabled early and rapid diagnosis of CMV viremia in transplant patients prior to symptoms. Also, in asymptomatic patients with CMV viremia, a decreased pulmonary diffusion capacity could be demonstrated. In this review, we discuss clinical and subclinical pulmonary involvement of CMV infection in the immunocompromised host with an emphasis on transplant recipients. The clinical course, diagnosis, therapy, prophylaxis, and pathophysiology of CMV pneumonitis are discussed.     

Leflunomide use in a cytomegalovirus infection of a patient with dermatomyositis

Human cytomegalovirus (CMV) is responsible for significant morbidity and mortality in immunocompromised populations, such as those suffering from dermatomyositis (DM). We present here a case study of a DM patient undergoing methotrexate treatment who presents with weakness, myalgia, elevated levels of hepatic transaminases and serological markers of CMV primo-infection. The antiviral activity of leflunomide against CMV was described recently. The use of leflunomide as an immunomodulator may have contributed to the satisfactory evolution of the treatment for a symptomatic CMV infection in an immunocompromised patient, since the typical treatment outcome is more prolonged and with additional complications.     

Ganciclovir treatment of cytomegalovirus infection of the gastrointestinal tract after marrow transplantation

Ganciclovir, an acyclic nucleoside with improved activity against cytomegalovirus in vitro, was used to treat 15 marrow transplant patients with symptomatic cytomegalovirus infection of the gastrointestinal tract. Eleven of the 15 had improvement in one or more of their clinical signs or symptoms during treatment. No clinical relapses were observed. Viral excretion from throat, urine and blood stopped at a median of 6 days of treatment, but six patients had recurrence of viral excretion 7-25 days after treatment was stopped. The only toxicity was the development of reversible neutropenia in eight of 15 patients after 10-19 days of treatment. Neutropenia was not related to duration of treatment, plasma drug levels or to the neutrophil count at the beginning of treatment. Although treatment with ganciclovir may be associated with marrow suppression, the serious nature of gastrointestinal infection due to cytomegalovirus in the immunocompromised host, the antiviral effect and the possible clinical improvement observed in vivo, and the lack of other effective treatments justify further controlled studies with this agent in immunocompromised patients with serious cytomegalovirus infection.     

Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease

A case of isolated necrotizing cytomegalovirus (CMV) oophoritis disclosed only by necropsy studies in a patient with AIDS, is described. This unusual case report is discussed with a review of the literature dealing with CMV involvement of genital organs in the immunocompromised host, and in patients with HIV infection and AIDS.     

Mycobacterium tuberculosis infection of a native polycystic kidney following renal transplantation

M.A. Rabbani, B. Ahmed, M.A. Khan. Mycobacterium tuberculosis infection of a native polycystic kidney following renal transplantation.
Transpl Infect Dis 2011: 13: 44–46. All rights reserved Abstract: Tuberculosis is a recognized complication following renal transplantation. Patients with autosomal‐dominant polycystic kidney disease are increasingly being offered renal transplantation as an alternative to chronic hemodialysis. These patients are uniquely susceptible to serious upper urinary tract infections that are associated with significant morbidity and mortality. While involvement with gram‐negative organisms is well described, mycobacterial infection of native polycystic kidneys after transplantation has not been addressed. We report a case of a renal transplant recipient who suffered an isolated Mycobacterium tuberculosis infection of a native polycystic kidney. With a 4‐drug anti‐tuberculosis therapy (ATT) regimen, the patient responded and became afebrile 8 weeks after initiation of drug therapy. ATT was continued for a total of 1 year. Two years after completion of ATT, the patient enjoys a normal life and has stable graft function. M. tuberculosis, though not common, must be recognized as a potential source of infection of native polycystic kidneys in immunocompromised transplant recipients. Similar to the pattern observed with more common pathogens, these infections may be difficult to eradicate with standard antimicrobial drug regimens.     

Quantification of CMV viraemia in a case of transfusion-related graft-versus-host disease associated with purine analogue treatment

We report a patient who developed transfusion-associated graft-versus-host-disease (GvHD) and concurrent cytomegalovirus (CMV) infection, both complications thought to be related to severe T lymphocyte depletion induced by treatment with a purine analogue drug, fludarabine. CMV viraemia was detected by qualitative PCR and the viral load in positive samples was measured using a fully quantitative PCR assay. This quantitative assay enabled the evaluation of the efficacy of antiviral interventions based on the qualitative PCR result. The case illustrates the risks associated with the use of purine analogue drugs, as well as the value of quantitative CMV PCR assays for monitoring CMV infection in immunocompromised patients.