Purg Darinka, Hojnik Marko, Kravos Tramšek Nika Aleksandra
Department of Gastroenterology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia.
Department of Pathology, University Medical Centre Maribor, Ljubljanska Ulica 5, 2000 Maribor, Slovenia.
Diagnostics (Basel). 2024 Nov 22;14(23):2633. doi: 10.3390/diagnostics14232633.
Cytomegalovirus (CMV) is a common cause of infection in immunocompromised individuals, such as patients with hematological malignancies or AIDS, but can also occur in patients with other acquired immunodeficiencies. In tissue-invasive diseases, CMV diagnosis requires CMV DNA in the plasma and the histological confirmation of CMV in a tissue or organ. Evidence of CMV colitis requires a characteristic endoscopic picture with ulcers with a well-defined, convex appearance and CMV viral inclusions in the form of an "owl's eye" on mucosal sections stained with hematoxylin and eosin. CMV-specific immunohistochemistry is the gold standard for identifying CMV in tissue biopsies. It is important to consider a CMV infection in the diagnostic process, as it may delay the diagnosis and the treatment. We present the case of a 78-year-old patient with amiodarone interstitial lung disease who was treated with methylprednisolone. Two weeks after the start of his treatment, he was admitted to the hospital for acute gastroenterocolitis and Addisonian crisis. An examination had confirmed a tissue-invasive CMV disease. He was treated with valganciclovir for a total of six weeks. After the completion of treatment, the patient showed no clinical signs of CMV infection, and both laboratory and histological examinations revealed no residual CMV disease. Tissue-invasive CMV disease can occur in patients with acquired immunodeficiency, which may result from various causes, including glucocorticoid treatment.
巨细胞病毒（CMV）是免疫功能低下个体感染的常见原因，如血液系统恶性肿瘤患者或艾滋病患者，但也可发生于其他获得性免疫缺陷患者。在组织侵袭性疾病中，CMV诊断需要血浆中CMV DNA以及组织或器官中CMV的组织学确认。CMV结肠炎的证据需要具有特征性的内镜表现，即溃疡外观清晰、凸起，且在苏木精和伊红染色的黏膜切片上有呈“猫头鹰眼”形式的CMV病毒包涵体。CMV特异性免疫组化是在组织活检中识别CMV的金标准。在诊断过程中考虑CMV感染很重要，因为它可能会延迟诊断和治疗。我们报告一例78岁使用胺碘酮所致间质性肺病患者，该患者接受了甲泼尼龙治疗。治疗开始两周后，他因急性胃肠炎和艾迪生病危象入院。检查证实为组织侵袭性CMV病。他接受了缬更昔洛韦治疗，共六周。治疗结束后，患者无CMV感染的临床症状，实验室和组织学检查均未发现残留的CMV病。组织侵袭性CMV病可发生于获得性免疫缺陷患者，其可能由多种原因引起，包括糖皮质激素治疗。
