Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.
World J Gastroenterol. 2016 Aug 21;22(31):7166-74.
Makker J1, Bajantri B1, Sakam S1, Chilimuri S1.
1Jasbir Makker, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States.
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.
PANCREATIC TOXICITY AS AN ADVERSE EFFECT INDUCED BY MEGLUMINE ANTIMONIATE THERAPY IN A CLINICAL TRIAL FOR CUTANEOUS LEISHMANIASIS. Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.