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Cytomegalovirus enteritis in common variable immunodeficiency.

Elizabeth Stack1, Kay Washington, George R Avant

  • 1Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-5280, USA.

Southern Medical Journal
|January 30, 2004
PubMed
Summary
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Cytomegalovirus (CMV) can cause severe gastrointestinal disease in individuals with common variable immunodeficiency (CVID). Early consideration of CMV is crucial for preventing mortality in CVID patients presenting with severe diarrhea.

Area of Science:

  • Gastroenterology
  • Immunology
  • Infectious Diseases

Background:

  • Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by impaired antibody production.
  • Patients with CVID are susceptible to opportunistic infections, including viral pathogens.
  • Gastrointestinal symptoms like diarrhea are common but can have diverse etiologies in CVID.

Observation:

  • A woman with undiagnosed CVID presented with severe diarrhea and dehydration.
  • Endoscopic biopsies showed atrophic gastritis, villous atrophy, and colitis, with an absence of plasma cells.
  • Cytomegalovirus (CMV) inclusions were identified in the small and large bowel mucosa.

Findings:

  • The patient's condition rapidly worsened despite treatment with intravenous immunoglobulin and ganciclovir.

Related Experiment Videos

  • The extensive gastrointestinal pathology was attributed to Cytomegalovirus infection.
  • The case demonstrates a fatal outcome due to a delay in diagnosing CMV in a CVID patient.

    • Implications:

    • Highlights the critical role of considering Cytomegalovirus in the differential diagnosis of severe gastrointestinal disease in CVID patients.
    • Early diagnosis and treatment of CMV in immunocompromised individuals can potentially prevent severe morbidity and mortality.
    • Emphasizes the need for heightened awareness among clinicians regarding opportunistic infections in primary immunodeficiencies.