Virus-associated hemophagocytic syndrome and hemorrhagic jejunal ulcer caused by cytomegalovirus infection in a non-compromised host; a case report of unusual entity.
A 76-year-old man was admitted to our hospital with abdominal pain, nausea, and vomiting. The patient was diagnosed as ileus by abdominal radiography, which showed an enlarged bowel and an air-fluid level. Computed tomography of the abdomen showed a thickened intestinal wall. His general status suddenly worsened, and he was placed on a respirator and catecholamines to prevent acute respiratory distress syndrome, septic shock, and disseminated intravascular coagulation. He had continuous fresh anal bleeding. Total colonoscopy showed bloody stool originating from the ileum. Emergency operation was performed for hemorrhagic shock under general anesthesia. Intraoperative jejunal endoscopy revealed deep linear ulcers with bleeding in the jejunum, and 30 cm of the jejunum was resected. Histopathologic examination revealed cytomegalic cells with intranuclear inclusion bodies in the tissues surrounding the ulcers, and it was diagnosed as cytomegaloviral enterocolitis with hemophagocytic syndrome in a non-compromised adult.
Ina
Shinomi
S
Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Tani
Masaji
M
Takifuji
Katsunari
K
Yamazoe
Shinji
S
Nakatani
Yoshihiro
Y
Yamaue
Hiroki
H
D000368:Aged; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004760:Enterocolitis / Q000150:complications* / Q000175:diagnosis / Q000821:virology*; D015616:Histiocytosis, Non-Langerhans-Cell / Q000821:virology*; D006801:Humans; D007579:Jejunal Diseases / Q000150:complications / Q000175:diagnosis; D008297:Male; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000601:surgery; D014456:Ulcer / Q000150:complications / Q000175:diagnosis