Berho M, Torroella M, Viciana A, Weppler D, Thompson J, Nery J, Tzakis A, Ruiz P
Department of Pathology, University of Miami School of Medicine, Florida 33101, USA.
Pediatr Transplant. 1998 Nov;2(4):277-82.
This report describes two cases of pediatric small bowel transplant patients who developed diffuse adenovirus enterocolitis of their allografts. Based upon the presenting symptoms for this complication, in both patients a differential diagnosis of allograft rejection versus viral infection was clinically entertained. The clinical condition in both instances rapidly deteriorated and both patients died shortly after the development of the symptoms of fulminant septicemia. Autopsies were performed and histologic examination revealed extensive denudation of the gastrointestinal mucosa with edema and a marked acute and chronic inflammatory infiltrate involving the entire wall of the grafts. Numerous viral intranuclear and intracytoplasmic inclusions were evident and an immunohistochemical stain specific for adenovirus was strongly positive in the infected cells. In addition, while in the first case the adenovirus appeared confined to the GI tract, the second patient displayed numerous viral inclusions in the lung as well as within multiple liver abscesses. At this point, the incidence of adenovirus as a cause of gastroenteritis in small bowel transplant patients remains to be determined. We believe that the importance of recognizing this particular type of viral infection in this group of patients lies primarily in differentiating it from other viral organisms (e.g., CMV) that require a specific antiviral therapy. Moreover, an identification of this entity could help avoid a misdiagnosis of rejection which could lead to an unnecessary increase in immunosuppressive therapy and a possible exacerbation of the underlying condition.
本报告描述了两例小儿小肠移植患者发生同种异体移植物弥漫性腺病毒小肠结肠炎的病例。根据该并发症的临床表现，这两名患者临床上均考虑了同种异体移植物排斥与病毒感染的鉴别诊断。两例患者的临床状况均迅速恶化，在暴发性败血症症状出现后不久均死亡。进行了尸检，组织学检查显示胃肠道黏膜广泛剥脱，伴有水肿，移植物全层有明显的急性和慢性炎性浸润。可见大量病毒核内和胞质内包涵体，针对腺病毒的免疫组化染色在感染细胞中呈强阳性。此外，在第一例中，腺病毒似乎局限于胃肠道，而第二例患者的肺以及多个肝脓肿内均显示有大量病毒包涵体。目前，腺病毒作为小肠移植患者胃肠炎病因的发生率仍有待确定。我们认为，在这类患者中认识到这种特殊类型病毒感染的重要性主要在于将其与其他需要特定抗病毒治疗的病毒病原体（如巨细胞病毒）区分开来。此外，识别这种疾病有助于避免将排斥反应误诊，否则可能导致免疫抑制治疗不必要的增加，并可能加重潜在病情。
