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Cytomegalovirus colitis after systemic chemotherapy in a patient with recurrent colon cancer: a case report.

Teraishi F, Shimamura H, Suzuki T, Nakamoto M, Chikuba A, Nezu M, Kohsaka S, Takiue T, Chikuba H - J Med Case Rep (2008)

Bottom Line: We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer.The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually.Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chikuba Hospital for Gastrointestinal and Colorectal Surgery, Kurashiki 710-0142, Japan. ftera@chikubageka.jp

ABSTRACT

Introduction: The occurrence of cytomegalovirus colitis is well known in immunosuppressed patients, such as neoplastic patients following chemotherapy, although its exact etiology remains unclear.

Case presentation: We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer. Initial colonoscopy revealed multiple punched-out ulcers in the transverse colon and the diagnosis of cytomegalovirus was based on positive cytomegalovirus antigen detected by indirect enzyme antibody method, although immunohistological examination of tissues biopsied at colonoscopy was negative. The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually.

Conclusion: The most probable cause of the cytomegalovirus colitis in this case was impaired immunity following chemotherapy. Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.

No MeSH data available.


Related in: MedlinePlus

Follow-up colonoscopy demonstrates partial healing of the ulcers in the transverse colon.
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Figure 3: Follow-up colonoscopy demonstrates partial healing of the ulcers in the transverse colon.

Mentions: Abdominal computed tomography imaging revealed a massive dilatation of the entire colon (Figure 1). Subsequently, a colonoscopy was performed, which revealed multiple punched-out ulcers in the transverse colon (Figure 2A and 2B) typical for CMV colitis. Following colonoscopy, CMV antigen was detected by indirect enzyme antibody method, also known as antigenemia method, but the biopsy specimens did not reveal CMV inclusion body immunohistologically. Based on these findings, the patient was diagnosed with CMV colitis and was started on intravenous ganciclovir therapy (500 mg/day for 2 weeks) combined with subcutaneous octreotide (200 mcg/day for 10 days). The patient gradually improved, and a second colonoscopy 4 weeks after admission demonstrated partial healing of multiple ulcers in the transverse colon (Figure 3).


Cytomegalovirus colitis after systemic chemotherapy in a patient with recurrent colon cancer: a case report.

Teraishi F, Shimamura H, Suzuki T, Nakamoto M, Chikuba A, Nezu M, Kohsaka S, Takiue T, Chikuba H - J Med Case Rep (2008)

Follow-up colonoscopy demonstrates partial healing of the ulcers in the transverse colon.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2542395&req=5

Figure 3: Follow-up colonoscopy demonstrates partial healing of the ulcers in the transverse colon.
Mentions: Abdominal computed tomography imaging revealed a massive dilatation of the entire colon (Figure 1). Subsequently, a colonoscopy was performed, which revealed multiple punched-out ulcers in the transverse colon (Figure 2A and 2B) typical for CMV colitis. Following colonoscopy, CMV antigen was detected by indirect enzyme antibody method, also known as antigenemia method, but the biopsy specimens did not reveal CMV inclusion body immunohistologically. Based on these findings, the patient was diagnosed with CMV colitis and was started on intravenous ganciclovir therapy (500 mg/day for 2 weeks) combined with subcutaneous octreotide (200 mcg/day for 10 days). The patient gradually improved, and a second colonoscopy 4 weeks after admission demonstrated partial healing of multiple ulcers in the transverse colon (Figure 3).

Bottom Line: We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer.The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually.Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Chikuba Hospital for Gastrointestinal and Colorectal Surgery, Kurashiki 710-0142, Japan. ftera@chikubageka.jp

ABSTRACT

Introduction: The occurrence of cytomegalovirus colitis is well known in immunosuppressed patients, such as neoplastic patients following chemotherapy, although its exact etiology remains unclear.

Case presentation: We present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer. Initial colonoscopy revealed multiple punched-out ulcers in the transverse colon and the diagnosis of cytomegalovirus was based on positive cytomegalovirus antigen detected by indirect enzyme antibody method, although immunohistological examination of tissues biopsied at colonoscopy was negative. The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually.

Conclusion: The most probable cause of the cytomegalovirus colitis in this case was impaired immunity following chemotherapy. Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy.

No MeSH data available.


Related in: MedlinePlus