Kaleida-Millard Fillmore Gates Circle Hospital, Buffalo, NY, USA.
Ann Pharmacother. 2011 Jan;45(1):e4. doi: 10.1345/aph.1P375. Epub 2010 Dec 28.
To report the improvement of diarrhea in a patient with cytomegalovirus (CMV) colitis who was treated with octreotide after failure of loperamide.
An 84-year-old male presented with chronic diarrhea and CMV colitis; he had been experiencing protracted diarrhea since 2006. In October 2009 he failed a 21-day course of valgancyclovir 900 mg orally twice daily. Several months later, due to continuing diarrhea and progressive malnutrition, a colonoscopy and subsequent biopsy again showed CMV. In March 2010 he was started on a 28-day course of intravenous ganciclovir 130 mg daily. Three weeks into treatment he continued with copious amounts of diarrhea, with no relief from loperamide, which was titrated from 2 mg/day to 2 mg every 6 hours. On day 20 of ganciclovir treatment he was started on octreotide 50 μg subcutaneously every 8 hours; within a few days, the patient began to experience decreased stool frequency and consistency. He completed the full 28-day course of ganciclovir, with octreotide continuing unchanged, with much improvement in his diarrheal symptoms and improvement in appetite, nutritional status, and quality of life.
Studies regarding the treatment of CMV colitis-associated diarrhea are scarce, and are typically limited to treating the underlying cause with antiviral medications and with the addition of antimotility agents. Three cases have been reported in the literature in which octreotide was used for the symptomatic treatment of diarrhea, none of which was refractory to loperamide.
This is the first known case of a patient with chronic diarrhea due to CMV colitis that was unresponsive to loperamide, required protracted antiviral treatment (valgancyclovir and gancyclovir), and subsequently experienced relief by the use of octreotide 50 μg subcutaneously every 8 hours.
报告一例使用奥曲肽治疗洛哌丁胺治疗失败的巨细胞病毒（CMV）结肠炎患者腹泻改善的情况。
一名 84 岁男性因 CMV 结肠炎出现慢性腹泻；他自 2006 年以来一直患有迁延性腹泻。2009 年 10 月，他接受了为期 21 天的缬更昔洛韦 900mg 口服，每日两次的治疗，但无效果。几个月后，由于持续腹泻和进行性营养不良，再次进行结肠镜检查和随后的活检显示仍为 CMV 感染。2010 年 3 月，他开始接受为期 28 天的更昔洛韦静脉滴注，每日 130mg。治疗 3 周后，他仍有大量腹泻，洛哌丁胺治疗无效，剂量从 2mg/天增加到每 6 小时 2mg。在更昔洛韦治疗的第 20 天，他开始每天皮下注射奥曲肽 50μg，每 8 小时一次；几天后，患者开始减少粪便频率和稠度。他完成了完整的 28 天更昔洛韦疗程，奥曲肽剂量不变，腹泻症状明显改善，食欲、营养状况和生活质量均有所提高。
关于 CMV 结肠炎相关性腹泻的治疗研究很少，通常仅限于使用抗病毒药物治疗潜在病因，并添加抗动力药物。文献中有 3 例报告使用奥曲肽治疗腹泻症状，均对洛哌丁胺无反应。
这是首例已知的慢性腹泻患者，因 CMV 结肠炎对洛哌丁胺无反应，需要长期抗病毒治疗（缬更昔洛韦和更昔洛韦），随后使用奥曲肽 50μg，皮下注射，每 8 小时一次，症状缓解。
