Cytomegalovirus Infection of the Gastrointestinal Tract in Patients on Hemodialysis: A Case Report and Literature Review

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Aug 9

PMID 39119410

Authors

Toshiyuki Nakanishi

Kazuhiro Ishikawa

Yusuke Ohashi

Takuya Fujimaru

Mori Nobuyoshi

Affiliations

Soon will be listed here.

Abstract

Cytomegalovirus (CMV) infection is widespread in immunocompromised people, and several cases of CMV infections of the gastrointestinal (GI) tract have been reported in these individuals. We present a case of an immunocompetent patient on hemodialysis (HD) who developed CMV colitis. We also conducted a review of the literature on CMV GI tract infections among patients with chronic kidney disease undergoing dialysis. A 46-year-old man with a history of end-stage renal disease and undergoing HD developed severe diarrhea and hematochezia. A colonoscopy revealed ulcers, and CMV infection was identified in the biopsy sample. We successfully treated the patient with valganciclovir for 2 months. Our review of the literature yielded 21 articles and 24 cases of CMV GI tract infection in patients undergoing dialysis, including the current case. Hematochezia and diarrhea were purported to serve as indicators of CMV GI tract infection among patients on dialysis. Thus, clinicians should suspect CMV infection of the GI tract in dialysis patients, who experience unexplained bloody diarrhea, and promptly perform a GI endoscopy and biopsy.

References

Quintana L, Collado S, Coll E, Lopez-Pedret J, Cases A . [Cytomegalovirus esophagitis in a patient on peritoneal dyalisis]. Nefrologia. 2005; 25(2):201-4. View

Tabernero G, Fernandez M, Teruel J, Redondo C, Echarri R, Ortuuno J . [Colitis due to cytomegalovirus in a dialysis patient]. Nefrologia. 2004; 24(3):279-82. View

Wetwittayakhlang P, Rujeerapaiboon N, Wetwittayakhlung P, Sripongpun P, Pruphetkaew N, Jandee S . Clinical Features, Endoscopic Findings, and Predictive Factors for Mortality in Tissue-Invasive Gastrointestinal Cytomegalovirus Disease between Immunocompetent and Immunocompromised Patients. Gastroenterol Res Pract. 2021; 2021:8886525. PMC: 8052155. DOI: 10.1155/2021/8886525. View

Liu C, Yang A, Ou S, Tarng D . The First Reported Case of Cytomegalovirus Gastritis in a Patient With End-Stage Renal Disease. Am J Med Sci. 2018; 355(6):607-609. DOI: 10.1016/j.amjms.2017.11.012. View

Sudcharoen A, Chonmaitree P, Poonyam P, Trongwongsa T . Cytomegalovirus Colitis in an End-Stage Renal Disease Patient Presenting with Lower Gastrointestinal Bleeding. J Med Assoc Thai. 2018; 99 Suppl 8:S237-S243. View

Ko J, Peck K, Lee W, Lee J, Cho S, Ha Y . Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients. Clin Infect Dis. 2014; 60(6):e20-6. DOI: 10.1093/cid/ciu969. View

Huang R, Benmassaoud A, Mayrand S . Severe Cytomegalovirus Infection Masquerading as Recurrent Ischemic Colitis in a Patient with End-Stage Renal Disease. ACG Case Rep J. 2018; 4:e126. PMC: 5741136. DOI: 10.14309/crj.2017.126. View

Esforzado N, Poch E, Almirall J, Bombi J, Lopez-Pedret J, Revert L . Cytomegalovirus colitis in chronic renal failure. Clin Nephrol. 1993; 39(5):275-8. View

Karakozis S, GONGORA E, Caceres M, Brun E, Cook J . Life-threatening cytomegalovirus colitis in the immunocompetent patient: report of a case and review of the literature. Dis Colon Rectum. 2001; 44(11):1716-20. DOI: 10.1007/BF02234398. View

10.

Chen Y, Hung Y, Huang C, Lee N, Chen C, Sung J . Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease. J Microbiol Immunol Infect. 2013; 47(4):345-9. DOI: 10.1016/j.jmii.2013.01.011. View

11.

Falagas M, Griffiths J, Prekezes J, Worthington M . Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. Am J Gastroenterol. 1996; 91(1):168-9. View

12.

Yeh P, Chiu C, Lai M, Wu R, Chen C, Kuo C . Clinical manifestations, risk factors, and prognostic factors of cytomegalovirus enteritis. Gut Pathog. 2021; 13(1):53. PMC: 8371416. DOI: 10.1186/s13099-021-00450-4. View

13.

Vaziri N, Pahl M, Crum A, Norris K . Effect of uremia on structure and function of immune system. J Ren Nutr. 2011; 22(1):149-56. PMC: 3246616. DOI: 10.1053/j.jrn.2011.10.020. View

14.

Matsumoto K, Shigemi A, Ikawa K, Kanazawa N, Fujisaki Y, Morikawa N . Risk factors for ganciclovir-induced thrombocytopenia and leukopenia. Biol Pharm Bull. 2015; 38(2):235-8. DOI: 10.1248/bpb.b14-00588. View

15.

Surawicz C, Myerson D . Self-limited cytomegalovirus colitis in immunocompetent individuals. Gastroenterology. 1988; 94(1):194-9. DOI: 10.1016/0016-5085(88)90630-0. View

16.

Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A . Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005; 50(4):609-16. DOI: 10.1007/s10620-005-2544-6. View

17.

Rafailidis P, Mourtzoukou E, Varbobitis I, Falagas M . Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J. 2008; 5:47. PMC: 2289809. DOI: 10.1186/1743-422X-5-47. View

18.

Rankin A, Cuthill K, Subesinghe M, Goldsmith D . Life-threatening rectal bleeding due to cytomegalovirus colitis in a haemodialysis patient. NDT Plus. 2015; 2(3):239-41. PMC: 4421198. DOI: 10.1093/ndtplus/sfp015. View

19.

Hsieh C, Chang M, Chen K, Jenq C, Li Y, Chen T . Concurrent Cytomegalovirus Colitis and Bacteroides fragilis Peritonitis in a Peritoneal Dialysis Patient. Perit Dial Int. 2015; 35(5):587-8. PMC: 4597993. DOI: 10.3747/pdi.2014.00078. View

20.

Maignan M, Wahl D, Thiaucourt D, Bach D, De Korwin J, Vaillant G . Self-limited primary cytomegalovirus colitis in an immunocompetent individual. J Intern Med. 1992; 232(4):357-9. DOI: 10.1111/j.1365-2796.1992.tb00598.x. View