Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA.
Department of Pathology, Stanford University, Stanford, California, USA.
Surg Infect (Larchmt). 2022 Mar;23(2):127-134. doi: 10.1089/sur.2021.173. Epub 2021 Dec 2.
We describe a patient with history of heart transplant on maintenance immunosuppression who presented with sigmoid colon perforation from cytomegalovirus (CMV) colitis and performed a systematic review of outcomes after perforated CMV colitis. Cytomegalovirus enterocolitis is uncommon among solid organ transplant patients and can result in small or large bowel perforation. We systematically reviewed articles describing patients with CMV enterocolitis with small or large bowel perforations from PubMed, Embase, and Web of Science from database inception to February 2021. Seventy-seven articles were identified containing 84 patients with perforated CMV enterocolitis. The most prevalent comorbid diagnosis was human immunodeficiency virus (HIV; 27 patients, 32%), and 37 patients (44%) were taking corticosteroids at time of presentation. The ileum was the most common location for a perforation (26 patients, 31%). Odds of survival were lower for patients with small bowel perforation (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.14-0.98) and HIV/acquired immunodeficiency syndrome (AIDS; OR, 0.32; 95% CI, 0.11-0.88). Odds of survival were higher for patients with large bowel perforation (OR, 2.64; 95% CI, 1.03-7.09), radiographically diagnosed perforation (OR, 3.45; 95% CI, 1.12-11.60) and those who received a CMV antiviral (OR, 9.19; 95% CI, 3.26-28.48). Perforated CMV enterocolitis is uncommon even in immunocompromised hosts. Clinicians should maintain a high level of suspicion for CMV-induced bowel perforation in this population because antiviral treatment is associated with increased odds of survival.
我们描述了一位接受心脏移植并维持免疫抑制治疗的患者，该患者因巨细胞病毒（CMV）结肠炎导致乙状结肠穿孔，并对穿孔性 CMV 结肠炎的结局进行了系统评价。巨细胞病毒性结肠炎在实体器官移植患者中并不常见，但可导致小肠或大肠穿孔。我们从 PubMed、Embase 和 Web of Science 数据库中检索了从数据库建立到 2021 年 2 月描述患有小肠或大肠穿孔的 CMV 结肠炎患者的文章，并进行了系统评价。共确定了 77 篇文章，其中包含 84 例穿孔性 CMV 结肠炎患者。最常见的合并诊断是人类免疫缺陷病毒（HIV；27 例，32%），37 例（44%）患者在就诊时正在服用皮质类固醇。穿孔最常见的部位是回肠（26 例，31%）。与小肠穿孔患者（比值比 [OR]，0.38；95%置信区间 [CI]，0.14-0.98）和 HIV/获得性免疫缺陷综合征（AIDS；OR，0.32；95%CI，0.11-0.88）相比，生存几率较低。与大肠穿孔患者（OR，2.64；95%CI，1.03-7.09）、影像学诊断穿孔（OR，3.45；95%CI，1.12-11.60）和接受 CMV 抗病毒治疗（OR，9.19；95%CI，3.26-28.48）的患者相比，生存几率更高。即使在免疫功能低下的宿主中，穿孔性 CMV 结肠炎也不常见。临床医生应在该人群中对 CMV 引起的肠穿孔保持高度警惕，因为抗病毒治疗与生存几率增加相关。
