CMV enterocolitis

CMV Enterocolitis : 

CMV Enterocolitis Dr S Sen SpR Gastroenterology Booth Hall Children Hospital

CMV infection : 

CMV infection CMV infection: congenital, acquired (peri- and postnatal) Clinical settings: immuno-compromised (congenital, acquired, iatrogenic), immuno-competent, in pre-existing IBD.

GI manifestations : 

GI manifestations Rare in imm-competent hosts Clinical syndromes: in imm-competent Clinical syndromes: in imm-compromised Localised or widespread GI tract Symptoms depending on distribution: upper or lower GI

Diagnosis : 

Diagnosis Histopathology Immunohistology Viral cultures CMV DNA by PCR of tissue biopsies CMV antigen assay in body fluids CMV serology by IFA Endoscopy Stool culture to r/o other organisms

Histopathological specimens revealing large cells with eosinophilic intranuclear and intracytoplasmic inclusions (black arrows), indicative of CMV. (H&E stain) : 

Histopathological specimens revealing large cells with eosinophilic intranuclear and intracytoplasmic inclusions (black arrows), indicative of CMV. (H&E stain)

Immunohistochemical analysis of cytomegalovirus (CMV) antigen in gastric biopsy specimens. : 

Immunohistochemical analysis of cytomegalovirus (CMV) antigen in gastric biopsy specimens. CMV antigen-positive cells

Treatment : 

Treatment Antivirals CMV hyperimmune globulin (refractory infection) Antidiarrhoeal Bowel rest (PN) Nutritional support (supplements)

Cases from BHCH 1 : 

Cases from BHCH 1 Example of immunocompromised patient AS 8y.o Iraqi boy with chronic ITP, post splenectomy. Dx with CMV enteropathy secondary to ?primary immunodeficiency and immunosuppresive drugs (azathioprine and cyclosporine). Dx confirmed on endoscopy, histopathology and antigen assays. Rx PN – elemental diet, 7week of Ganciclovir. Reduced viral load in bloods, symptoms improved.

Cases from BHCH 2 : 

Cases from BHCH 2 Example of immunocompetent infant Pt AA 5m old Pakistani boy with chronic diarrhoea, severe failure to thrive and severe atopy. Dx with postnatally acquired CMV infection, suspected cows milk intolerance and CMV enteropathy . Dx confirmed by CMV antigen assays in blood and urine. Colitis so far not supported by colonoscopy, histopathology and antigen assays in biopsy material. Rx - PN, 4 weeks of Ganciclovir, Neocate. Atopy symptoms improved, CMV PCR not detected in blood, still frequent loose stools.

References : 

References Cytomegalovirus-associated protracted diarrhoea in an immunocompetent boy. Japan. Journal of Paediatrics and Child Health 42 (2006) 259-262 Another cause of bloody diarrhoea in infancy: Cytomegalovirus colitis in an immunocompetent child UK. Journal of Paediatrics and Child Health 40 (2004) 581-582 An immunocompetent infant with cow’s milk allergy and cytomegalovirus colitis. Netherlands. European Journal of Pediatrics (1997) 156:528-529 Cytomegalovirus colitis in an immunocompetent patient. USA. The Internet Journal of Gastroenterology. 2008. Volume 7 (1) Severe cytomegalovirus enterocolitis in an immunocompetent infant. USA. The Pediatric Infectious Disease Journal 2004 Volume 23 (6) Paediatric Gastrointestinal disease and Nutrition. Ch35 (3) CMV – gastroenetritis/colitis. Illustrated Health Encyclopaedia. Review 2006

Thank you! : 

Thank you!