دانلود رایگان مقاله سیتومگالوویروس آنتریت در بیماران سالم با استفاده از انتروسکوپی تک بالون

Summary

Cytomegalovirus (CMV) infection of the gastrointestinal tract involves mostly the colon and rectum and mainly develops in immunocompromised patients. CMV infection in the small intestines has rarely been reported in immunocompetent patients. We report two cases of CMV enteritis that developed in immunocompetent patients and involved the ileum and jejunum, respectively. Both of them were diagnosed with single-balloon enteroscopy (SBE) and further confirmed with histopathology. The first case is a 71-year-old woman with a presentation of obscure gastrointestinal bleeding and severe anemia. Neither esophagogastroduodenoscopy nor colonoscopy identified any active bleeding. SBE and biopsy disclosed multiple scattered ulcers in the distal ileum and histopathology confirmed CMV ileitis. The hemorrhage subsided after conservative medical treatment. The second case is a 59-yearold woman with a presentation of progressive abdominal pain. SBE showed diffuse irregularly-shaped ulcers located from the upper to middle jejunum, and CMV jejunitis was confirmed with endoscopic biopsy and histopathological examination. Antiviral therapy was prescribed and her abdominal pain improved gradually. We discuss the clinical manifestations and management strategies of CMV infection that develops in the small intestines of immunocompetent patients. In addition, we highlight the endoscopic characteristics of CMV enteritis and the clinical utilities of SBE in the evaluation of patients with suspected CMV infection of the small intestines.

Discussion

The diagnosis of CMV infection of the GI tract, especially the small intestines, in immunocompetent hosts is challenging. Among the rarely reported cases in the literature, most present with nonspecific symptoms, including poor appetite, abdominal pain, vomiting, and ileus, and were usually diagnosed with laparotomy for profuse bleeding or bowel perforation [4,7]. Most cases with CMV ileitis over terminal ileum were diagnosed using colonoscopy [2] and only one case of CMV jejunitis was diagnosed with SBE [8]. A high index of clinical suspicion for CMV enteritis and early institution of SBE is necessary to avoid delaying the correct diagnosis.