Hasegawa Tsuyoshi, Aomatsu Kazuki, Nakamura Masanori, Aomatsu Naoki, Aomatsu Keiho
Tsuyoshi Hasegawa, Kazuki Aomatsu, Masanori Nakamura, Naoki Aomatsu, Keiho Aomatsu, Department of Surgery, Aomatsu Memorial Hospital, Izumisano, Osaka 598-0001, Japan.
World J Gastroenterol. 2015 Mar 28;21(12):3750-4. doi: 10.3748/wjg.v21.i12.3750.
We report a rare case of cytomegalovirus (CMV) colitis followed by severe ischemic colitis in a non-immunocompromised patient. An 86-year-old woman was admitted after experiencing episodes of vomiting and diarrhea. The next day, hematochezia was detected without abdominal pain. The initial diagnosis of ischemic colitis was based on colonoscopy and histological findings. The follow-up colonoscopy revealed a prolonged colitis. Immunohistochemical staining detected CMV-positive cells following conservative therapy. Intravenous ganciclovir therapy led to successful healing of ulcers and disappearance of CMV-positive cells. The prevalence of CMV infection is common in adults. CMV colitis is relatively common in immunocompromised patients; however, it is rare in immunocompetent patients. In our case, CMV infection was allowed to be established due to the disruption of the colonic mucosa by the prior severe ischemic colitis. Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed.
我们报告了一例罕见的巨细胞病毒（CMV）结肠炎病例，该病例发生在一名非免疫功能低下的患者身上，随后发展为严重的缺血性结肠炎。一名86岁女性在经历呕吐和腹泻发作后入院。第二天，在无腹痛的情况下检测到便血。缺血性结肠炎的初步诊断基于结肠镜检查和组织学检查结果。后续结肠镜检查显示结肠炎病程延长。保守治疗后，免疫组织化学染色检测到CMV阳性细胞。静脉注射更昔洛韦治疗使溃疡成功愈合，CMV阳性细胞消失。CMV感染在成年人中很常见。CMV结肠炎在免疫功能低下的患者中相对常见；然而，在免疫功能正常的患者中却很少见。在我们的病例中，由于先前严重的缺血性结肠炎破坏了结肠黏膜，使得CMV感染得以确立。我们的经验表明，可能需要进行活检来检测CMV，并且当观察到难治性缺血性结肠炎时，应立即对CMV结肠炎进行治疗。
