Sudcharoen Asawin, Chonmaitree Piyanant, Poonyam Piyakorn, Trongwongsa Therdkiat
J Med Assoc Thai. 2016 Nov;99 Suppl 8:S237-S243.
The authors report a case of cytomegalovirus colitis which is one of uncommon causes of lower gastrointestinal bleeding in a patient with end-stage renal disease receiving hemodialysis. Our patient presented with recurrent episodes of massive hematochezia within 2 months. He had the underlying end-stage renal disease, ischemic heart disease, cerebrovascular disease, hypertension and gout. Colonoscopy revealed multiple clean base ulcers at rectum and sigmoid colon. An active bleeding lesion was rectal ulcer with non bleeding visible vessel which was successfully treated with hemoclipping. The diagnosis of cytomegalovirus colitis was confirmed by pathology from colonic tissues which showed compatible patterns of cytopathic change. Human immunodeficiency virus serology was negative. He was treated with with ganciclovir intravenously for 1 week after the pathological finding was reported. To our knowledge, cytomegalovirus infection should be considered as causative pathogen of colitis and colonic ulcers in end-stage renal disease patients.
作者报告了一例巨细胞病毒性结肠炎病例，这是接受血液透析的终末期肾病患者下消化道出血的罕见原因之一。我们的患者在2个月内出现反复发作的大量便血。他患有潜在的终末期肾病、缺血性心脏病、脑血管疾病、高血压和痛风。结肠镜检查显示直肠和乙状结肠有多个基底干净的溃疡。一个活动性出血病灶是直肠溃疡，有不可见的出血血管，通过止血夹成功治疗。结肠组织病理学证实了巨细胞病毒性结肠炎的诊断，其显示出符合细胞病变改变的模式。人类免疫缺陷病毒血清学检查为阴性。在报告病理结果后，他接受了1周的静脉注射更昔洛韦治疗。据我们所知，巨细胞病毒感染应被视为终末期肾病患者结肠炎和结肠溃疡的致病病原体。
