Colon Cytomegalovirus Infection: A Case Report with Rare Endoscopic Presentations

重度大腸道巨細胞病毒感染：一例罕見之內視鏡所見報告

陳志弘(Chih-Hung Chen) ； 郭仲謀(Chung-Mou Kuo) ； 胡琮輝(Tsung-Hui Hu) ； 蔡成枝(Seng-Kee Chuah) ； 張簡吉(Chi-Sin Changchien)

《內科學誌》 19卷1期 (2008/02) Pp. 67-71

https://doi.org/10.6314/JIMT.2008.19(1).10

摘要

巨細胞病毒(CMV)感染常發生在嚴重免疫能力缺損的病人。那些後天免疫不全症候群、移植手術後接受免疫抑制治療或惡性腫瘤接受化學治療和長期使用類固醇的病人，皆爲高危險群。巨細胞病毒感染可能存在於病人的胃腸道內，但衹有少數病人會發生臨床上明顯的症狀。感染巨細胞病毒最重要的診斷標準在於排除其它的感染病原如黴菌、其它病毒、寄生蟲和細菌感染後，並在被感染細胞中可發現病毒的包涵體(inclusion body)。我們在此報導了一個72歲的女性多發性骨髓瘤病人，因大量血便，而接受大腸內視鏡檢查，內視鏡發現因爲嚴重大暘發炎而導致彌漫性潰瘍和罕見的僞息肉病灶。從大腸病灶部位取得切片檢體，並以hematoxylin & eosion stain染色和針對巨細胞病毒單株抗體(anti-CMV monoclonal antibody)特別免疫組織化學染色，可以發現巨細胞病毒的包涵體。雖立即於診斷後以ganciclovir治療，但病患臨床症狀仍持續惡化而死亡。

並列摘要

Cytomegalovirus (CMV) infection can occur in severely immunocompromised populations, such as people suffering from acquired immunodeficiency syndrome (AIDS), patients receiving immunosuppressive therapy after transplantation or undergoing chemotherapy for malignanies, and long-term corticosteroid users. CMV frequently occurs in the gastrointestinal tract of such immunocompromised individuals, but only a few of them develop clinically apparent CMV disease. The gold standard of diagnosis for CMV infection is the presence of viral inclusion bodies in infected cells, after the exclusion of other viral, fungal, parasitic, and bacterial infections. CMV colitis results in lesions varying from segmental to extensive mucosal ulcerations. We report a rare endoscopic feature of severe and extensive colitis, resembling pseudo-polyp lesions, observed in a 72-year-old woman with myelomatosis who had suffered from progressive bloody diarrhea and abdominal pain for one month. Histological examination of biopsies from the ulcer bases, stained with hematoxylin and eosin (H&E) and an immunohistochemical stain for anti-CMV monoclonal antibody confirmed the presence of CMV inclusion bodies. The patient expired despite treatment with ganciclovir

並列關鍵字

Cytomegalovirus CMV ； Severe gastrointestinal tract infection ； Pseudopolyp colonic lesions