Baystate Regional Cancer Program/Tufts University School of Medicine, Springfield, MA 01107, USA.
BMC Infect Dis. 2011 May 17;11:131. doi: 10.1186/1471-2334-11-131.
Chronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician. Norovirus infection, a major cause of acute epidemic diarrhea, has been described as a cause of chronic diarrhea in patients who are immunosuppressed, including transplant recipients and the very young.
We describe two patients, a 64 year-old man and a 59 year-old woman, both suffering from chronic lymphocytic leukemia and hypogammaglobulinemia, who developed chronic diarrhea resistant to therapy. In both cases, after months of symptoms, persistent norovirus infection--documented by repeatedly-positive high-sensitivity stool enzyme immunoassay--was found to be the cause. Both patients died with active diarrheal symptoms.
We describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection. Clinicians caring for such patients, particularly those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis.
接受免疫抑制剂治疗或患有免疫抑制性疾病的患者出现慢性腹泻，这对临床医生来说是一个诊断和治疗上的挑战。诺如病毒感染是急性流行性腹泻的主要病因之一，已被描述为导致免疫抑制患者（包括移植受者和非常年幼的患者）慢性腹泻的原因。
我们描述了两名患者，一名 64 岁男性和一名 59 岁女性，均患有慢性淋巴细胞白血病和低丙种球蛋白血症，他们出现了对治疗有抗性的慢性腹泻。在这两种情况下，在出现症状数月后，通过反复检测到高灵敏度粪便酶免疫测定呈阳性，发现持续的诺如病毒感染是病因。两名患者均死于有症状的腹泻。
我们描述了首例患有晚期慢性淋巴细胞白血病且患有持续性有症状诺如病毒感染的病例。对此类患者进行治疗的临床医生，特别是那些同时患有低丙种球蛋白血症、有慢性不明原因腹泻的患者，应将诺如病毒感染纳入鉴别诊断。
