Protein-losing gastroenteropathy and retinitis associated with cytomegalovirus infection in an immunocompetent infant: a case report

Protein-losing gastroenteropathy and retinitis associated with cytomegalovirus infection in an immunocompetent infant: a case report. are lacking. We propose that CMV should be included in the differential diagnosis of intractable diarrhea in immunocompetent children. toxin assay, rotavirus and Giardia antigens were unfavorable. Three ova and parasite examinations revealed few trophozoites by trichrome stain, which were considered clinically insignificant. Due to his failure to gain weight despite optimized caloric intake, an exploratory EGD and flexible sigmoidoscopy was performed. On evaluation, the EGD was grossly normal, Narciclasine but flexible sigmoidoscopy revealed a friable colon with multiple ulcerations. On histology, colonic biopsies exhibited multiple cytoplasmic and intranuclear viral inclusions, without evidence of crypt destruction or loss of epithelial architecture. CMV inclusions were predominantly identified in the colonic lamina propria (See Physique, Supplemental Digital Content 2A, B, C). IHC staining for CMV showed multiple CMV inclusion bodies, consistent with CMV contamination (See Physique, Supplemental Digital Content 2D). A subsequent CMV plasma PCR detected 28,000 IU/mL. Immunology evaluation consisting of HIV antibody, quantitative immunoglobulins, pneumococcal antibody titers, and T-cell, B-cell and NK-cell subsets, was normal. The patient did not require anti-viral therapy, and his diarrhea spontaneously resolved, with subsequent weight gain on high calorie elemental formula. A repeat plasma CMV PCR was performed one week later, and viral load decreased to of 280 IU/mL without anti-viral therapy. Methods We performed a literature search in Medline using PubMed through May 5, 2015, to identify cases of CMV colitis reported among immunocompetent children, utilizing the search terms Narciclasine cytomegalovirus, immunocompetent, colitis, enterocolitis, contamination, pediatric and children. Articles and citations were carefully reviewed, cross referenced, and cases included if affected individuals were less than 18 years of age, exhibited documented evidence of CMV contamination by histology or tissue, stool or plasma PCR, and had clinical symptoms consistent with colitis. Non clinical (ie animal) studies, congenital infections, infections among pre-term infants, or cases of non-colonic CMV disease were excluded. Individual case data, including age, gender, birth weight, gestational age at birth, diet, white blood cell count at presentation, and immunologic workup, were collected and analyzed to characterize salient features of this cohort. Results We identified 93 reports of invasive CMV disease among presumably immunocompetent children. Of these, 19 reports describing a total of 21 cases met our criteria and, including the two presented here, comprise a total of 23 cases of invasive CMV enterocolitis among term, presumably immunocompetent Narciclasine children. The diagnosis was confirmed by histology (IHC or viral inclusions) in 16/24 cases (67%), tissue PCR in 3 cases (Cases 5, 14, 16), stool PCR in 2 cases (cases 13, 15), and blood PCR alone in 2 cases (cases 6, 17). Children diagnosed by serum CMV PCR exhibited positive CMV IgM at the time of diarrhea, and in the treated case (case 6), dramatic clinical improvement within 2 days of antiviral therapy. One child (case 9) was diagnosed by CMV IHC of a gastric biopsy; however, given the secretory nature of his diarrhea, enteric involvement was deemed to be highly likely. Patient characteristics are reported in Table 1. The majority of cases were identified among young, male infants (median age at presentation 2.5 months) with Narciclasine no history of intrauterine growth retardation, prematurity, or prior infectious history. The majority of patients (72%) were exclusively breast fed at the time of illness, three had associated cows milk protein allergy (CMPA) at the time of presentation, and four had a documented history of poor weight gain prior to Narciclasine their illness. Table 1 Reported cases of invasive CMV enterocolitisin immunocompetent infants. GCV, ganciclovir; VGCV, valganciclovir; TPN, total parenteral nutrition. thead th align=”center” valign=”bottom” rowspan=”1″ colspan=”1″ Case /th th align=”center” valign=”bottom” rowspan=”1″ colspan=”1″ Author /th th align=”center” valign=”bottom” rowspan=”1″ colspan=”1″ Rabbit Polyclonal to OR10Z1 12 months /th th align=”center” rowspan=”1″ colspan=”1″ Age br / (m) /th th align=”center” valign=”bottom” rowspan=”1″ colspan=”1″ Gender /th th align=”center” rowspan=”1″ colspan=”1″ Breast br / Fed /th th align=”center” rowspan=”1″ colspan=”1″ Bloody br / Stool /th th align=”center” valign=”bottom” rowspan=”1″ colspan=”1″ Ganciclovir /th th align=”left” rowspan=”1″ colspan=”1″ Outcome / br / Complications /th /thead 1Huang [1]19961.5FNoNoNoIleal perforation2Jonkhoff [2]19971.5MNoYesNoRecovered.