Successful treatment of Good syndrome with cytomegalovirus duodenoenteritis using a combination of ganciclovir and immunoglobulin with high anti-cytomegalovirus antibody titer.
We describe the case of a 64-year-old woman with Good syndrome who presented with watery diarrhea and abdominal distention caused by cytomegalovirus (CMV) duodenoenteritis. Thymoma and hypogammaglobulinemia were first identified when the patient was 58 years old. She had repeatedly complained of symptoms even after thymectomy. Abdominal radiography revealed multiple air-fluid levels, and computed tomography revealed ascites and dilation of the small intestine. Immunofluorescent staining of specimens obtained by duodenal mucosal biopsy revealed intracellular inclusion bodies of CMV, although serum CMV pp65 antigenemia assays yielded negative results. CMV infection of the small intestine caused mucosal edema resulting in malabsorption. The patient was treated using ganciclovir and an immunoglobulin preparation with a high titer of antibodies against CMV (CMV-Ig), and subsequently made a rapid recovery from abdominal symptoms. When patients with Good syndrome complain of abdominal symptoms, particularly chronic diarrhea, a diagnosis of CMV gastroenteritis should not be excluded, even if negative results are obtained for CMV pp65 antigenemia assays. Combination therapy of ganciclovir and CMV-Ig seems useful for patients with CMV gastroenteritis.
Koriyama
Nobuyuki
N
First Department of Internal Medicine, Kagoshima University, Japan.
Fukumoto
Osamu
O
Fukudome
Michiyo
M
Aso
Katsumi
K
Hagiwara
Takafumi
T
Arimura
Kosei
K
Nakazaki
Mitsuhiro
M
Arima
Naomichi
N
Eizuru
Yoshito
Y
Tei
Chuwa
C
D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004382:Duodenitis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D005759:Gastroenteritis / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008875:Middle Aged; D013934:Thymectomy; D013945:Thymoma / Q000150:complications* / Q000601:surgery; D013953:Thymus Neoplasms / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome
D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D015774:Ganciclovir