Lin Robert K, Behling Cynthia A, Garvie John J
Department of Medicine, Division of Gastroenterology, University of California, San Diego, San Diego 92103-8413, California.
AIDS Patient Care STDS. 2004 Sep;18(9):497-500. doi: 10.1089/apc.2004.18.497.
Cytomegalovirus infection occurs in immunocompromised patients. We present a 45-year-old male with no prior medical history who presented to the hospital with weight loss and non-bloody diarrhea. During hospitalization, he developed severe hematochezia and hypotension. Colonoscopy revealed dusky, friable mucosa. The patient arrested and was resuscitated. Specimen from emergent colectomy showed ischemic changes secondary to cytomegalovirus infection of endothelium and small-vessel thrombosis. An HIV test was subsequently positive with CD4 count of 2 per microliter. The patient was treated with antiretroviral therapy and ganciclovir. He survived postoperative infections and was eventually discharged. In summary, this case of near-fatal cytomegalovirus colitis represents an unusual presentation of undiagnosed HIV infection. Cytomegalovirus infection should be included in the differential diagnosis of immunocompromised patients with gastrointestinal symptoms. Hematochezia may be from intestinal ulceration or severe ischemic damage. Antiretroviral therapy and ganciclovir or foscarnet should be initiated promptly. Surgery is indicated in life-threatening hemorrhage or obvious bowel necrosis.
巨细胞病毒感染发生在免疫功能低下的患者中。我们报告一例45岁男性，既往无病史，因体重减轻和非血性腹泻入院。住院期间，他出现严重便血和低血压。结肠镜检查显示黏膜呈暗褐色、质脆。患者心跳骤停后经复苏成功。急诊结肠切除术标本显示，由于巨细胞病毒感染内皮导致缺血性改变以及小血管血栓形成。随后HIV检测呈阳性，CD4细胞计数为每微升2个。患者接受了抗逆转录病毒治疗和更昔洛韦治疗。他在术后感染中存活下来，最终出院。总之，这例近乎致命的巨细胞病毒性结肠炎是未确诊HIV感染的一种不寻常表现。对于有胃肠道症状的免疫功能低下患者，鉴别诊断时应考虑巨细胞病毒感染。便血可能源于肠道溃疡或严重缺血性损伤。应立即开始抗逆转录病毒治疗以及使用更昔洛韦或膦甲酸钠。对于危及生命的出血或明显的肠坏死，应进行手术治疗。
