Cytomegalovirus infection presenting as isolated inflammatory polyps of the gastrointestinal tract
ABSTRACT Gastrointestinal involvement by cytomegalovirus (CMV) infection is a well recognised complication in patients taking steroid/immunosuppressive therapy or suffering from immunodeficiency and debilitating diseases. Rarely, CMV may affect immunocompetent healthy individuals. However, CMV infection presenting as isolated inflammatory polyps is unusual.
We describe five patients (1 infant and 4 adults 56-80 years of age) with CMV-associated polyps that posed diagnostic difficulty. Four lesions were initially misdiagnosed as inflammatory fibroid polyp (n = 2), atypical/suspicious lymphoproliferative (n = 1) and mesenchymal (n = 1) lesion.
Underlying diseases were kidney transplantation (1), ulcerative colitis (1), and HIV infection (1). One elderly patient had pseudomembranous colitis but no significant co-morbidity. One patient had no relevant diseases. The lesions affected the colon (3), small intestine (1) and gastric antrum (1); one was multifocal. The size ranged from 0.3 cm to 2.0 cm. Histologically, all lesions showed extensive surface ulceration and abundant capillary-rich granulation tissue containing activated lymphoid cells, plasma cells, granulocytes, enlarged histiocytes and atypical fibroblasts. Eosinophils were prominent in two cases. Immunohistochemistry showed unequivocal intranuclear CMV inclusions.
These cases widen the spectrum of endoscopic and histological appearance of gastrointestinal CMV infection. Awareness of these unusual lesions should enhance detection and proper classification of this probably under-recognised CMV presentation.
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ABSTRACT: Cytomegalovirus (CMV) is the most common viral infection in solid organ transplant recipients. Symptomatic infection usually presents with fever, pneumonia, colitis, or cytopenia. We describe a case of symptomatic CMV infection in a liver transplant recipient presenting with atypical symptoms of only persistent nausea and vomiting, in the absence of classical symptoms and signs; thus, highlighting the importance of high index of suspicion of CMV in immunocompromised patients, keeping in mind the high morbidity and mortality associated with this disease.12/2011; 1(3):207–209. DOI:10.1016/S0973-6883(11)60236-3
- Digestive Endoscopy 03/2013; 25(3). DOI:10.1111/den.12044 · 1.99 Impact Factor
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ABSTRACT: Diffuse neurofibromatosis/ ganglioneuromatosis, solitary/ plexiform neurofibroma, periampullary carcinoids and gastrointestinal stromal tumour (GIST) are the main gastrointestinal manifestations of neurofibromatosis type 1 (NF-1, von Recklinghausen disease). Inflammatory (juvenile-like) polyps still have not been recognized as specific gastrointestinal manifestations of NF-1. We describe 4 males aged 23-65 years with NF-1 and inflammatory (juvenile-like) gastrointestinal polyps and review the literature for similar cases. Two patients had single polyps (sigmoid colon and antrum, respectively), 1 had two polyps (left colon) and 1 had 3 polyps (distal esophagus and colon). Histology revealed variable appearance ranging from juvenile-like to granulation tissue-rich predominantly inflammatory and hyperplastic. Three lesions showed obliterative vasculopathic changes. None had neurofibromatous or ganglioneuromatous polyps. Review of the literature disclosed 11 similar cases. Most patients presented with severe gastrointestinal symptoms and/or anemia. NF-1-associated inflammatory polyps probably represent specific GI manifestations of this disorder and should be thought of, particularly in patients with GI symptoms. They should be distinguished from inflammatory fibroid polyps and from juvenile-like changes associated with ganglioneuroma/tosis and neurofibroma/tosis. Their etiology remains obscure but different mechanisms including NF-1 inactivation, NF-1-associated vasculopathy and localized mucosal prolapse/damage caused by motility disorders might be involved. This article is protected by copyright. All rights reserved.Histopathology 11/2013; DOI:10.1111/his.12325 · 3.30 Impact Factor