TY - JOUR
T1 - Cytomegalovirus colitis in intensive care unit patients
T2 - Difficulties in clinical diagnosis
AU - Chan, Khee Siang
AU - Yang, Chun Chieh
AU - Chen, Chi-Ming
AU - Yang, His Hsing
AU - Lee, Ching Chien
AU - Chuang, Yin Ching
AU - Yu, Wen Liang
PY - 2014/6
Y1 - 2014/6
N2 - Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.
AB - Purpose: Cytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients. Methods: CMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea. Results: We identified 18 patients (biopsy-proved, n = 8; probable cases, n = 10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients. Conclusion: Diagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.
KW - Acute hemorrhagic rectal ulcer
KW - Cytomegalovirus colitis
KW - Immunohistochemical stain
KW - Polymerase chain reaction
KW - Pseudomembranous colitis
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U2 - 10.1016/j.jcrc.2014.01.003
DO - 10.1016/j.jcrc.2014.01.003
M3 - Article
C2 - 24556151
AN - SCOPUS:84899984433
SN - 0883-9441
VL - 29
SP - 474.e1-474.e6
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 3
ER -
