Landry M L, Fong C K, Neddermann K, Solomon L, Hsiung G D
Virology Reference Laboratory/Veterans Administration Medical Center, West Haven, Connecticut 06516.
Am J Med. 1987 Sep;83(3):555-9. doi: 10.1016/0002-9343(87)90770-4.
In this report, a bone marrow transplant recipient with rapidly fatal gastroenteritis is presented. The presence of intranuclear inclusions on postmortem light microscopic examination of liver, lung, and small bowel tissue was considered diagnostic of cytomegalovirus infection. However, electron microscopic examination of liver tissue demonstrated adenovirus infection. This was confirmed by isolation of an adenovirus type 2 with unusual laboratory features from liver, lung, colon contents, serum, esophageal swab, and oral ulcerations. Results of a complement fixation test for antibodies to adenovirus performed on postmortem serum samples were negative, and a titer of 1:4 was noted for antibody against cytomegalovirus. This case illustrates the diagnostic pitfalls that may be encountered in establishing a specific viral diagnosis in severely ill patients.
本报告介绍了一名骨髓移植受者，其患有迅速致命的胃肠炎。在对肝脏、肺和小肠组织进行尸检光镜检查时发现核内包涵体，曾被认为是巨细胞病毒感染的诊断依据。然而，对肝脏组织进行电子显微镜检查显示为腺病毒感染。从肝脏、肺、结肠内容物、血清、食管拭子和口腔溃疡中分离出具有不寻常实验室特征的2型腺病毒，证实了这一诊断。对尸检血清样本进行的腺病毒抗体补体结合试验结果为阴性，而巨细胞病毒抗体滴度为1:4。该病例说明了在对重症患者进行特定病毒诊断时可能遇到的诊断陷阱。
