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A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma.

Han KJ, Jung IS, Kim CK, Park SK, Kim DW, Baick SH, Won JH, Hong DS, Hwang SD, Moon C, Park HS - Korean J. Intern. Med. (1998)

Bottom Line: Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed.The treatment of choice is antiviral agent or surgical resection.We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

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Surgical specimen of jejunum a: Several discrete ulcers, irregular in shape and size, are seen. Intervening mucosa showed irregularity, nodularity, and pseudopolyp appearance, b: The ulcer base consist of necrotic exudate.
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f1-kjim-13-2-143-14: Surgical specimen of jejunum a: Several discrete ulcers, irregular in shape and size, are seen. Intervening mucosa showed irregularity, nodularity, and pseudopolyp appearance, b: The ulcer base consist of necrotic exudate.

Mentions: In operation fields, jejunal segment of small intestine showed a diffuse inflammatory process. There were dark blood clots in distal jejunum and ileum. The involved area of the small intestine was removed and the intestinal continuity was reestablished by end to end anastomosing the upper jejunum to the terminal ileum. The resection specimen consisted of 48-cm-long portion of jejunum. Grossly, there were multiple ill-defined ulcerations surrounded by irregular nodularities of mucosa(Fig 1 a, b). On histologic examination, the ulcer base was consisted of necrotic exudate and granulation tissue. Also, on HE stain, there was many enlarged cells with purple intranuclear inclusions surrounded by a clear halo and smaller basophilic cytoplasmic inclusion mainly in the submucosa and muscle layer of ulcerative areas. It suggested the cytomegalovirus infection of jejunum(Fig 2 a). On histologic examination of endoscopic biopsy specimen of esophagus and stomach, there were small basophilic inclusion bodies in endothelial cells and glandular cells(Fig 2 b). In our case, we performed the immunohistochemical staining to detect pp65 antigen of CMV in cytospin preparations of peripheral blood neutrophils(Fig 3 a) and paraffin-embedded surgical specimen of jejunum by the APAAP(alkaline phosphatase antialkaline phosphatase)(Clonal CMVKit, Biotest, Germany) method(Fig 3 b). Also, IF stain using DAKO-CMV, DDG9 and CCH2(DAKO, USA) for immediate early CMV antigen was performed from urine shell vial culture which showed heavy CMV infection.


A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma.

Han KJ, Jung IS, Kim CK, Park SK, Kim DW, Baick SH, Won JH, Hong DS, Hwang SD, Moon C, Park HS - Korean J. Intern. Med. (1998)

Surgical specimen of jejunum a: Several discrete ulcers, irregular in shape and size, are seen. Intervening mucosa showed irregularity, nodularity, and pseudopolyp appearance, b: The ulcer base consist of necrotic exudate.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4531948&req=5

f1-kjim-13-2-143-14: Surgical specimen of jejunum a: Several discrete ulcers, irregular in shape and size, are seen. Intervening mucosa showed irregularity, nodularity, and pseudopolyp appearance, b: The ulcer base consist of necrotic exudate.
Mentions: In operation fields, jejunal segment of small intestine showed a diffuse inflammatory process. There were dark blood clots in distal jejunum and ileum. The involved area of the small intestine was removed and the intestinal continuity was reestablished by end to end anastomosing the upper jejunum to the terminal ileum. The resection specimen consisted of 48-cm-long portion of jejunum. Grossly, there were multiple ill-defined ulcerations surrounded by irregular nodularities of mucosa(Fig 1 a, b). On histologic examination, the ulcer base was consisted of necrotic exudate and granulation tissue. Also, on HE stain, there was many enlarged cells with purple intranuclear inclusions surrounded by a clear halo and smaller basophilic cytoplasmic inclusion mainly in the submucosa and muscle layer of ulcerative areas. It suggested the cytomegalovirus infection of jejunum(Fig 2 a). On histologic examination of endoscopic biopsy specimen of esophagus and stomach, there were small basophilic inclusion bodies in endothelial cells and glandular cells(Fig 2 b). In our case, we performed the immunohistochemical staining to detect pp65 antigen of CMV in cytospin preparations of peripheral blood neutrophils(Fig 3 a) and paraffin-embedded surgical specimen of jejunum by the APAAP(alkaline phosphatase antialkaline phosphatase)(Clonal CMVKit, Biotest, Germany) method(Fig 3 b). Also, IF stain using DAKO-CMV, DDG9 and CCH2(DAKO, USA) for immediate early CMV antigen was performed from urine shell vial culture which showed heavy CMV infection.

Bottom Line: Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed.The treatment of choice is antiviral agent or surgical resection.We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT
CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

Show MeSH
Related in: MedlinePlus