Laurent S, Reenaers C, Detroz B, Detry O, Delvenne Ph, Belaiche J, Meurisse M
Dept of Abdominal Surgery, CHU Sart Tilman B35, B-4000 Liège, Belgium.
Acta Gastroenterol Belg. 2005 Apr-Jun;68(2):276-9.
The authors report the case of a patient aged 60-year-old who survived ulcerative colitis complicated by toxic megacolon and disseminated intravascular coagulation. This patient was not known for this ulcerative colitis and was first hospitalised for a suspicion of diverticulitis. The admission symptoms were fever, abdominal pain and bloody diarrhoea. The evolution was defavorable under antibiotics and sulfasalazine. The patient was readmitted 5 days after he left hospital, and the diagnosis of UC was based on colon biopsy made during the first hospitalisation. A treatment with methylprednisolone was started and the patient worsened day by day with apparition of toxic megacolon and disseminated intravascular coagulation. Subtotal colectomy was performed for degradation of general status and coagulation factors. Pathological findings confirmed ulcerative colitis with toxic megacolon. Cytomegalovirus inclusions were demonstrated on the colonic specimen and confirmed by PCR. In this report the authors discuss the etiology of toxic megacolon and disseminated intravascular coagulation in ulcerative colitis surinfected by cytomegalovirus. Mortality of these pathologies is high necessitating rapid diagnosis of cytomegalovirus infection by sigmoid biopsy. Management requires immunosupression interruption and ganciclovir therapy, or surgery in unsuccessful medical treatment.
作者报告了一例60岁患者的病例，该患者在溃疡性结肠炎并发中毒性巨结肠和弥散性血管内凝血后存活。该患者此前并不知晓患有溃疡性结肠炎，最初因疑似憩室炎入院。入院症状为发热、腹痛和血性腹泻。在使用抗生素和柳氮磺胺吡啶治疗后病情好转。患者出院5天后再次入院，溃疡性结肠炎的诊断基于首次住院期间进行的结肠活检。开始使用甲泼尼龙治疗，但患者病情日益恶化，出现了中毒性巨结肠和弥散性血管内凝血。因全身状况和凝血因子恶化而进行了次全结肠切除术。病理结果证实为溃疡性结肠炎合并中毒性巨结肠。在结肠标本上发现了巨细胞病毒包涵体，并通过聚合酶链反应得到证实。在本报告中，作者讨论了巨细胞病毒感染的溃疡性结肠炎中中毒性巨结肠和弥散性血管内凝血的病因。这些病症的死亡率很高，需要通过乙状结肠活检快速诊断巨细胞病毒感染。治疗需要中断免疫抑制并进行更昔洛韦治疗，或在药物治疗无效时进行手术。
