Yao-Ming Chen1, Yuan-Pin Hung2, Chien-Fang Huang3, Nan-Yao Lee4, Chiung-Yu Chen5, Junne-Ming Sung5, Chia-Ming Chang4, Po-Lin Chen6, Ching-Chi Lee4, Yi-Hui Wu7, Hsiao-Ju Lin2, Wen-Chien Ko8. 1. Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan. 2. Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan; Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan. 3. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan. 4. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan. 5. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan. 6. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Graduate Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan. 7. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Internal Medicine, PingTung Christian Hospital, PingTung, Taiwan. 8. Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan; Center for Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Medicine, Medical College, National Cheng Kung University, Tainan, Taiwan. Electronic address: winston3415@gmail.com.
Abstract
BACKGROUND/PURPOSE(S): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. METHODS: Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. RESULTS: Seven CKD patients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8, 57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3 ± 1.3 kg/m(2)) and hypoalbuminemia (25 ± 7.0 g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. CONCLUSION: CMV disease may occur in CKD patients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKD patients who have GI symptoms.
BACKGROUND/PURPOSE(S): To identify the clinical characteristics of cytomegalovirus (CMV) disease in chronic kidney disease (CKD) patients. METHODS:Patients from two sources were reviewed: (1) a retrospective study of hospitalized patients admitted between January 1990 and February 2009 was performed at a tertiary hospital in Taiwan; (2) the English literature from 1990 to 2009 was reviewed for additional cases, and adults with CKD and histopathologically documented cytomegalovirus disease were included. RESULTS: Seven CKDpatients from our hospital and seven from the literature were included. Nine (64.3%) patients were males, and the mean age was 66 years. Histopathologically proven CMV disease was present in the gastrointestinal (GI) tract of 13 (92.9%) and in the skin of one (7.1%) patient. GI symptoms included bleeding (78.6%), abdominal pain (35.7%), and diarrhea (28.6%).The most common comorbidities were diabetes mellitus (7, 50%) and hypertension (8, 57.1%). Thirteen patients had CMV GI disease. The endoscopic gross features of the GI tract lesions included single or multiple ulcers and a large polypoid or uneven surface mass. Of the seven cases with available data, a low body mass index (22.3 ± 1.3 kg/m(2)) and hypoalbuminemia (25 ± 7.0 g/L) were noted. Twelve patients had received ganciclovir or valganciclovir therapy. Five (35.7%) patients died, and the death of two patients was directly related to bowel perforation caused by CMV colitis. CONCLUSION: CMV disease may occur in CKDpatients without the presence of overt immunodeficiency. The gastrointestinal tract is the most common site of involvement. Clinicians should be aware of this possibility in CKDpatients who have GI symptoms.
Authors: J-H Ko; K R Peck; W J Lee; K Huh; J R Yoo; K Kim; S Y Cho; Y E Ha; C-I Kang; D R Chung; C W Jung; Y-H Kim; N Y Lee; K-M Kim; J-H Song Journal: Eur J Clin Microbiol Infect Dis Date: 2014-05-23 Impact factor: 3.267