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Adenovirus enterocolitis in human small bowel transplants
M Berho1, M Torroella, A Viciana
1Department of Pathology, University of Miami School of Medicine, Florida 33101, USA.
Pediatric Transplantation
|March 20, 1999
Summary
Two pediatric small bowel transplant patients developed fatal adenovirus enterocolitis. Early diagnosis is crucial to differentiate viral infection from allograft rejection, avoiding harmful immunosuppression increases.
Area of Science:
- Gastroenterology
- Transplant Surgery
- Virology
Background:
- Small bowel transplantation is a complex procedure with significant risks.
- Graft rejection and opportunistic infections are major challenges in transplant recipients.
- Distinguishing between rejection and infection is critical for appropriate patient management.
Observation:
- Two pediatric patients developed diffuse adenovirus enterocolitis post-small bowel transplant.
- Clinical presentation mimicked allograft rejection, complicating diagnosis.
- Rapid clinical deterioration and septicemia preceded patient demise.
Findings:
- Autopsy revealed extensive gastrointestinal mucosal damage and inflammation in the allografts.
- Histopathology showed viral inclusions, confirmed as adenovirus via immunohistochemistry.
- Adenovirus infection extended beyond the GI tract in one patient, affecting lungs and liver.
Implications:
- Adenovirus enterocolitis is a severe complication in small bowel transplant recipients.
- Accurate differentiation from allograft rejection is vital for treatment.
- Avoiding misdiagnosis prevents unnecessary immunosuppression escalation, potentially improving outcomes.