Cytomegalovirus proctitis mimicking rectal cancer in an immunocompetent elderly patient: a case report

BMC Research Notes

Giovanni Satta¹  Julia Rees¹  Adam M Gwozdz²  Tolu Adesina²  Anthony O’Sullivan²  Sathyavani Subbarao¹ 

[1] Department of Pathology, North Middlesex University Hospital, Sterling Way, N181QX London, UK;Elderly Care, North Middlesex University Hospital, Sterling Way, N181QX London, UK

关键词: Cell-mediated immunity;    Colitis;    CMV;   

Others  :  1123271
DOI  :  10.1186/1756-0500-7-799

 received in 2013-10-25, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

Cytomegalovirus infection is associated with significant morbidity and mortality in immunocompromised patients, but its impact on immunocompetent patients is still poorly understood. Furthermore, there is increasing evidence implying that chronic infection may contribute to a heightened cardiovascular risk.

Case presentation

We describe the case of incidental diagnosis of Cytomegalovirus proctitis in an immune-competent white British elderly gentleman, admitted following a stroke and investigated for rectal cancer following the development of bloody diarrhoea and persistent systemic inflammatory response.

Conclusion

This raised some several interesting points; firstly that we must revise our approach to investigating the immunocompetent elderly patient, secondly, could chronic Cytomegalovirus infection have contributed to the presentation of stroke in this patient and lastly what are the existing evidence for treatment in this population? We use this opportunity to try and address some of these questions and feel that this would be of benefit to the wider audience.

We discuss the risk factors for disease in immune-competent patients and also a brief overview of the benefits of treatment in this population.

【 授权许可】

   
2014 Subbarao et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Emery VC: Investigation of CMV disease in immunocompromised patients. J Clin Pathol 2001, 54:84-88.
• [2]Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME: Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008, 5:47. BioMed Central Full Text
• [3]de la Hoz RE, Stephens G, Sherlock C: Diagnosis and treatment approaches of CMV infections in adult patients. J Clin Virol 2002, 25(Suppl 2):S1-S12.
• [4]Ho M: Epidemiology of cytomegalovirus infections. Rev Infect Dis 1990, 12(Suppl 7):S701-S710.
• [5]Cicin-Sain L, Brien JD, Uhrlaub JL, Drabig A, Marandu TF, Nikolich-Zugich J: Cytomegalovirus infection impairs immune responses and accentuates T-cell pool changes observed in mice with aging. PLoS Pathog 2012, 8:e1002849.
• [6]Goodgame RW: Gastrointestinal cytomegalovirus disease. Ann Intern Med 1993, 119:924-935.
• [7]Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A: Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 2005, 50:609-616.
• [8]Schmucker DL, Heyworth MF, Owen RL, Daniels CK: Impact of aging on gastrointestinal mucosal immunity. Dig Dis Sci 1996, 41:1183-1193.
• [9]Weinberger B, Lazuardi L, Weiskirchner I, Keller M, Neuner C, Fischer KH, Neuman B, Wurzner R, Grubeck-Loebenstein B: Healthy aging and latent infection with CMV lead to distinct changes in CD8+ and CD4+ T-cell subsets in the elderly. Hum Immunol 2007, 68:86-90.
• [10]Savva GM, Pachnio A, Kaul B, Morgan K, Huppert FA, Brayne C, Moss PA, Ageing S, Medical Research Council Cognitive F: Cytomegalovirus infection is associated with increased mortality in the older population. Aging Cell 2013, 12:381-387.
• [11]Szary NM, Kuwajima VK, Jiang PP, Puli SR, Bragg JD, Bechtold ML: Cytomegalovirus colitis in an immunocompetent host: a case report and review of the literature. Int J Gastroenterol 2007, 7:1.
• [12]Cook CH, Trgovcich J, Zimmerman PD, Zhang Y, Sedmak DD: Lipopolysaccharide, tumor necrosis factor alpha, or interleukin-1beta triggers reactivation of latent cytomegalovirus in immunocompetent mice. J Virol 2006, 80:9151-9158.
• [13]Zedtwitz-Liebenstein K, Jaksch P, Wulkersdorfer B, Friehs H, Pempelfort SD, Burgmann H, Frass M: Usefulness of interleukin-10 detection in lung transplant patients with human cytomegalovirus infection with respect to virus persistence. Transplantation 2007, 84:268-271.
• [14]Osawa R, Singh N: Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 2009, 13:R68. BioMed Central Full Text
• [15]Phillips AN, Carr A, Neuhaus J, Visnegarwala F, Prineas R, Burman WJ, Williams I, Drummond F, Duprez D, Belloso WH, Goebel FD, Grund B, Hatzakis A, Vera J, Lundgren JD: Interruption of antiretroviral therapy and risk of cardiovascular disease in persons with HIV-1 infection: exploratory analyses from the SMART trial. Antivir Ther 2008, 13:177-187.
• [16]Squizzato A, Ageno W, Cattaneo A, Brumana N: A case report and literature review of portal vein thrombosis associated with cytomegalovirus infection in immunocompetent patients. Clin Infect Dis 2007, 44:e13-e16.
• [17]Danesh J, Collins R, Peto R: Chronic infections and coronary heart disease: is there a link? Lancet 1997, 350:430-436.