Histologically proved cytomegalovirus as a terrible and neglect disease: a 13-year report of gastrointestinal and hepatobiliary manifestations from single referral center

• Published in: Comparative clinical pathology 2017-11, Vol.26 (6), p.1253-1257
• Main Authors: Feridouni, Farshad, Geramizadeh, Bita, Sepehrimanesh, Masood, Safarpour, Ali Reza, Fattahi, Mohammadreza
• Format: Article
• Language: English
• Subjects: Antigens; Corticosteroids; Cyclosporins; Cytomegalovirus; Diarrhea; Disease; Ganciclovir; Hematology; Infections; Inflammatory bowel diseases; Intestine; Kidney transplantation; Liver diseases; Medicine; Medicine & Public Health; Mortality; Oncology; Organ donors; Original Article; Pathology; Polymerase chain reaction; Pp65 protein; Transplantation
• ISSN: 1618-5641; 1618-565X
• DOI: 10.1007/s00580-017-2516-1

The aim of the present study was to evaluate the gastrointestinal and hepatobiliary manifestation of cytomegalovirus. In a retrospective study, demographic and clinical information of patients with gastrointestinal or hepatobiliary manifestations and histologically confirmed cytomegalovirus infection was investigated among pathological records. The association between serum cytomegalovirus pp65 and blood positivity of cytomegalovirus polymerase chain reaction with histological findings was also evaluated. Of the 74 included patients, 27 cases (36.5%) were female. The most common symptoms were diarrhea (24.3%). Unusual presentations of cytomegalovirus diseases were gastrointestinal obstruction, refractory peptic ulcer, and corticosteroid-refractory inflammatory bowel disease. In total, 54 cases (75.0%) were transplanted, with the most frequency of kidney transplantation in 32 patients (59.2%). These patients had also more mortality rate. The most prescribed medicine in transplanted patients was CellCept and cyclosporine (40.6%). Mortality rate was more in blood polymerase chain reaction-negative patients. Cytomegalovirus diseases in transplanted patients were more primary infection compared with reactivation infection. No significant difference in mortality rate was seen between ganciclovir and non-ganciclovir recipients. The majority of the patients were negative for antigen or polymerase chain reaction. Early detection of cytomegalovirus could be lifesaving, and negative results of antigen and polymerase chain reaction cannot rule out cytomegalovirus diseases. Early endoscopic evaluation for unusual presentations of cytomegalovirus disease and also liver donor evaluation should be done more carefully. Ganciclovir has no significant effect on mortality of the patients, and then, it should be started at appropriate time.