Pop Corina Silvia, Becheanu Gabriel, Calagiu Dorina, Jantea Petruţa-Violeta, Rădulescu Dragoş Mihai, Pariza George, Mavrodin Carmen-Iuliana, Bold Adriana, Costache Adrian, Nemeş Roxana Maria
Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;
Rom J Morphol Embryol. 2015;56(4):1535-40.
We report a case of CMV (cytomegalovirus) infection in a Crohn's disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohn's disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohn's disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohn's disease was established. Although the specific treatment was initiated, patient's general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding - hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohn's ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohn's disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome.
我们报告一例克罗恩病患者发生巨细胞病毒（CMV）感染，导致严重噬血细胞综合征并死亡。一名63岁男性，有10年回肠和结肠克罗恩病病史，在过去一个月出现全身不适、食欲不振和体重减轻。他曾临床缓解两年，接受5-氨基水杨酸（5-ASA）衍生的美沙拉嗪维持治疗。该患者既往未使用过免疫调节剂或免疫抑制治疗。进行了结肠镜检查，我们发现其表现提示为活动性克罗恩病，经组织病理学检查确诊。确诊为克罗恩病加重。尽管开始了特异性治疗，但患者的一般状况逐渐恶化，出现腹泻，随后发生大量胃肠道出血——便血。我们再次进行结肠镜检查，病理检查显示为克罗恩回结肠炎合并CMV感染。尽管开始使用更昔洛韦并采取了其他重症监护措施，但他的病情仍日益恶化，胸部X线检查证实有多叶肺炎。迅速进展的全血细胞减少、弥散性血管内凝血的证据以及高铁蛋白血症的出现，引发了对噬血细胞综合征的怀疑，骨髓穿刺证实了这一点。因此，确诊为在近期针对克罗恩病进行皮质激素治疗背景下的CMV相关噬血细胞综合征。有充分证据支持炎症性肠病（IBD）患者，尤其是接受免疫调节剂治疗的患者中CMV感染的严重性。噬血细胞综合征在免疫缺陷情况下感染患者中反应性发生，表现为多器官功能障碍综合征的血液学方面。
