Cakir Murat, Ersoz Safak, Akbulut Ulas Emre
Department of Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University, Trabzon, Turkey.
Department of Pathology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Pediatr Gastroenterol Hepatol Nutr. 2015 Mar;18(1):60-5. doi: 10.5223/pghn.2015.18.1.60. Epub 2015 Mar 30.
We report a pediatric patient admitted with abdominal pain, diffuse lower extremity edema and watery diarrhea for two months. Laboratory findings including complete blood count, serum albumin, lipid and immunoglobulin levels were compatible with protein losing enteropathy. Colonoscopic examination revealed diffuse ulcers with smooth raised edge (like "punched out holes") in the colon and terminal ileum. Histopathological examination showed active colitis, ulcerations and inclusion bodies. Immunostaining for cytomegalovirus was positive. Despite supportive management, antiviral therapy, the clinical condition of the patient worsened and developed disseminated cytomegalovirus infection and the patient died. Protein losing enteropathy and disseminated cytomegalovirus infection a presenting of feature in steroid-naive patient with inflammatory bowel disease is very rare. Hypogammaglobulinemia associated with protein losing enteropathy in Crohn's disease may predispose the cytomegalovirus infection in previously healthy children.
我们报告了一名儿科患者，因腹痛、双下肢弥漫性水肿及水样腹泻入院，病程长达两个月。实验室检查结果，包括全血细胞计数、血清白蛋白、血脂及免疫球蛋白水平，均符合蛋白丢失性肠病。结肠镜检查显示结肠和回肠末端有边缘光滑隆起（类似“穿孔”）的弥漫性溃疡。组织病理学检查显示活动性结肠炎、溃疡及包涵体。巨细胞病毒免疫染色呈阳性。尽管给予了支持治疗和抗病毒治疗，但患者的临床状况仍恶化，并发播散性巨细胞病毒感染，最终死亡。蛋白丢失性肠病和播散性巨细胞病毒感染作为初治炎性肠病患者的特征表现非常罕见。克罗恩病中与蛋白丢失性肠病相关的低丙种球蛋白血症可能使先前健康的儿童易患巨细胞病毒感染。
