Department of Gastroenterology, Mitsubishi Kyoto Hospital, Kyoto, Japan.
Department of Internal Medicine, Yurin Hospital, Tokyo, Japan.
BMC Gastroenterol. 2022 Apr 28;22(1):209. doi: 10.1186/s12876-022-02274-1.
Eosinophilic enteritis is a chronic inflammatory disorder of the intestinal tract that is characterized by eosinophil infiltration. Cytomegalovirus (CMV), a common virus, has a broad infectivity range. CMV is retained in the host body after infection. Impairment of host immune defences may reactivate the latent CMV, leading to symptoms of overt disease.
A Japanese female in her 70 s was admitted to a hospital due to diarrhoea and then transferred to our hospital. Laboratory data showed hypoalbuminemia. Computed tomography (CT) revealed oedema of the small intestine. Lower gastrointestinal endoscopy revealed oedema of the submucosa, without any remarkable changes in the mucosa of the terminal ileum. Histological examination of the terminal ileum revealed infiltration of > 20 eosinophils per high-power field (HPF). These findings aided in diagnosing eosinophilic enteritis. We administered methylprednisolone (500 mg/day) for three days, followed by tapering prednisolone. However, the patient's general condition and hypoalbuminemia failed to improve. Immunoglobulin (Ig) G- CMV and IgM-CMV tests were positive. CMV antigenemia was extremely high. Therefore, we administered ganciclovir intravenously, which improved the patient's condition. Furthermore, azathioprine was administered to taper and discontinue prednisolone without relapse of eosinophilic enteritis. This treatment helped stabilize the patient's condition for approximately four years.
We present a case of eosinophilic enteritis accompanied by CMV disease during prednisolone treatment. The patient's condition improved after administration of ganciclovir. Azathioprine aided in discontinuing prednisolone and stabilizing the patient's condition for approximately four years.
嗜酸性粒细胞性肠炎是一种以嗜酸性粒细胞浸润为特征的慢性肠道炎症性疾病。巨细胞病毒（CMV）是一种常见的病毒，具有广泛的感染范围。感染后，CMV 会在宿主体内被保留。宿主免疫防御功能的损害可能会使潜伏的 CMV 重新激活，导致显性疾病的症状。
一位 70 多岁的日本女性因腹泻住院，随后转入我院。实验室数据显示低白蛋白血症。计算机断层扫描（CT）显示小肠水肿。下消化道内镜检查显示黏膜下水肿，末端回肠无明显变化。末端回肠的组织学检查显示每高倍镜视野（HPF）浸润的嗜酸性粒细胞>20 个。这些发现有助于诊断嗜酸性粒细胞性肠炎。我们给予甲基强的松龙（500mg/天）治疗 3 天，然后逐渐减少泼尼松龙的剂量。然而，患者的一般情况和低白蛋白血症并未改善。免疫球蛋白（Ig）G-CMV 和 IgM-CMV 检测呈阳性。CMV 抗原血症极高。因此，我们给予更昔洛韦静脉注射，患者病情得到改善。此外，给予硫唑嘌呤以逐渐减少并停用泼尼松龙，且未出现嗜酸性粒细胞性肠炎复发。这种治疗方法帮助患者的病情稳定了大约四年。
我们报告了一例在泼尼松龙治疗期间并发 CMV 病的嗜酸性粒细胞性肠炎。给予更昔洛韦后患者病情改善。硫唑嘌呤有助于停用泼尼松龙并使患者的病情稳定约四年。
