Alukal Joseph, Asif Mohammed, Mundada Rachana, McNamee William B
Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA.
Department of Surgery, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA.
BMJ Case Rep. 2018 Jan 4;2018:bcr-2017-221121. doi: 10.1136/bcr-2017-221121.
Cytomegalovirus (CMV) colitis usually occurs in patients with advanced immunosuppression when the CD4 count is <50 cells/μL. We reported a case of recurrent CMV colitis in a patient with HIV who presented with profuse lower gastrointestinal bleed. This was a case of immune reconstitution inflammatory syndrome (IRIS) manifesting as CMV colitis and has been reported only once in the literature previously. This patient had a CD4 count of 157 cells/μL and undetectable viral load after being on antiretroviral therapy (ART) for 5 months, which was consistent with IRIS. The diagnosis of CMV was confirmed by a colonoscopy and a biopsy. This case highlights the fact that CMV colitis can manifest despite a moderately preserved CD4 count and the clinicians must have a high index suspicion for IRIS syndrome especially when someone was recently started on ART. Since effective treatment is available, it is important not to miss the diagnosis of CMV colitis.
巨细胞病毒（CMV）结肠炎通常发生在免疫抑制严重、CD4细胞计数<50个/μL的患者中。我们报告了一例HIV患者复发性CMV结肠炎，该患者出现大量下消化道出血。这是一例表现为CMV结肠炎的免疫重建炎症综合征（IRIS），此前文献中仅报道过一次。该患者在接受抗逆转录病毒治疗（ART）5个月后，CD4细胞计数为157个/μL，病毒载量检测不到，这与IRIS相符。通过结肠镜检查和活检确诊为CMV。该病例突出了一个事实，即尽管CD4计数中度保留，CMV结肠炎仍可能出现，临床医生必须对IRIS综合征有高度怀疑指数，尤其是当有人最近开始接受ART时。由于有有效的治疗方法，因此不漏诊CMV结肠炎很重要。
