Hosokawa Shinobu, Bessho Akihiro, Kagawa Mai, Oda Masahiro, Sakugawa Makoto
Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, JPN.
Department of Clinical Laboratory, Japanese Red Cross Okayama Hospital, Okayama, JPN.
Cureus. 2024 Jul 20;16(7):e64986. doi: 10.7759/cureus.64986. eCollection 2024 Jul.
A 71-year-old man was admitted because of acute exacerbation of interstitial pneumonia following a right upper lobectomy for lung cancer. His respiratory failure worsened after admission, and he required mechanical ventilation. He was undergoing intensive immunosuppressive treatment, including high-dose corticosteroids and cyclosporine, and had watery diarrhea six times a day. White blood cells were found in the stool, and an intestinal infection was suspected. Fecal cultures showed no pathogenic bacteria. Multiplex polymerase chain reaction for gastrointestinal infection yielded negative results. Based on the increasing number of cytomegalovirus (CMV) antigen-positive cells in the CMV antigenemia assay, we suspected CMV colitis. However, the patient was still undergoing mechanical ventilation, and colonoscopy was difficult to perform. After explaining the procedure to the patient and obtaining his consent, the BioFire® FilmArray® Meningitis/Encephalitis (ME) Panel was performed using a fecal specimen. CMV was detected. Intravenous infusion of ganciclovir at 5 mg/kg was immediately commenced and administered every 12 hours for three weeks. Intravenous infusion at 5 mg/kg was continued every 24 hours thereafter for a further three weeks. When CMV colitis is suspected but the patient's condition prevents tissue collection through colonoscopy and standard diagnosis by histopathology, the addition of CMV PCR using a stool sample may assist in the clinical diagnosis of CMV colitis. The use of multiplex polymerase chain reaction is expected to contribute to prompt and appropriate treatment.
一名71岁男性因肺癌右上叶切除术后间质性肺炎急性加重入院。入院后其呼吸衰竭加重，需要机械通气。他正在接受强化免疫抑制治疗，包括大剂量皮质类固醇和环孢素，且每天腹泻6次，呈水样便。粪便中发现白细胞，怀疑有肠道感染。粪便培养未发现病原菌。针对胃肠道感染的多重聚合酶链反应结果为阴性。基于巨细胞病毒（CMV）抗原血症检测中CMV抗原阳性细胞数量增加，我们怀疑为CMV结肠炎。然而，患者仍在接受机械通气，难以进行结肠镜检查。在向患者解释该操作并获得其同意后，使用粪便标本进行了BioFire® FilmArray® 脑膜炎/脑炎（ME）检测板检测。检测到CMV。立即开始静脉输注更昔洛韦，剂量为5mg/kg，每12小时一次，持续三周。此后每24小时继续静脉输注5mg/kg，再持续三周。当怀疑为CMV结肠炎但患者病情妨碍通过结肠镜检查采集组织及进行组织病理学标准诊断时，增加使用粪便样本进行CMV PCR检测可能有助于CMV结肠炎的临床诊断。多重聚合酶链反应的应用有望有助于及时、恰当的治疗。
