title: A rare complication of CMV infection in Crohn's disease - hemophagocytic syndrome: a case report.
abstract: We report a case of CMV (cytomegalovirus) infection in a Crohn's disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohn's disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohn's disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohn's disease was established. Although the specific treatment was initiated, patient's general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding - hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohn's ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohn's disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome.
authors.affiliation: Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; adriancostacheeco@yahoo.com.
authors.forename: Corina Silvia
authors.initials: CS
authors.lastname: Pop
authors.forename: Gabriel
authors.initials: G
authors.lastname: Becheanu
authors.forename: Dorina
authors.initials: D
authors.lastname: Calagiu
authors.forename: Petruţa-Violeta
authors.initials: PV
authors.lastname: Jantea
authors.forename: Dragoş Mihai
authors.initials: DM
authors.lastname: Rădulescu
authors.forename: George
authors.initials: G
authors.lastname: Pariza
authors.forename: Carmen-Iuliana
authors.initials: CI
authors.lastname: Mavrodin
authors.forename: Adriana
authors.initials: A
authors.lastname: Bold
authors.forename: Adrian
authors.initials: A
authors.lastname: Costache
authors.forename: Roxana Maria
authors.initials: RM
authors.lastname: Nemeş
mesh_terms: D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000473:pathology; D042783:Endothelial Cells / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D007413:Intestinal Mucosa / Q000473:pathology; D051359:Lymphohistiocytosis, Hemophagocytic / Q000150:complications* / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013601:T-Lymphocytes / Q000473:pathology