Catastrophic gastrointestinal complication of systemic immunosuppression.
We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.
Lyn Alexandra Smith, Daniel R Gaya, Gastroenterology Unit, Glasgow Royal Infirmary, G4 0SF Glasgow, United Kingdom.
Lyn Alexandra
LA
Smith
Lyn Alexandra Smith, Daniel R Gaya, Gastroenterology Unit, Glasgow Royal Infirmary, G4 0SF Glasgow, United Kingdom.
Mitali
M
Gangopadhyay
Lyn Alexandra Smith, Daniel R Gaya, Gastroenterology Unit, Glasgow Royal Infirmary, G4 0SF Glasgow, United Kingdom.
Daniel R
DR
Gaya
D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003520:Cyclophosphamide / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D004382:Duodenitis / Q000139:chemically induced / Q000276:immunology / Q000821:virology; D016099:Endoscopy, Gastrointestinal; D004941:Esophagitis / Q000139:chemically induced / Q000276:immunology / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology / Q000628:therapy / Q000821:virology; D006561:Herpes Simplex / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D011239:Prednisolone / Q000009:adverse effects*; D056647:Systemic Vasculitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone
Cytomegalovirus; Endoscopy; Gastrointestinal haemorrhage; Herpes simplex virus; Immunosuppression