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Tc-99m red blood cell scintigraphic detection of CMV-induced small bowel hemorrhage
Nikhil Bhagat1, Nasrin V Ghesani, Iona M Monteiro
1Department of Radiology, Division of Pediatric Gastroenterology, New Jersey Medical School, Newark, NJ 07103, USA.
Insights
A pediatric HIV case with gastrointestinal bleeding was diagnosed with cytomegalovirus enteritis. This highlights CMV enteritis as a critical consideration in immunocompromised children with GI hemorrhage.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Immunocompromised Hosts
Background:
- Human Immunodeficiency Virus (HIV) infection in children can lead to moderate immunosuppression.
- Pneumocystis carinii pneumonia (PCP) is a common opportunistic infection in pediatric HIV.
- Gastrointestinal (GI) hemorrhage is a serious complication in immunocompromised pediatric patients.
Observation:
- A 4-month-old female with HIV and PCP presented with hematochezia (bloody stools).
- A Technetium-99m (Tc-99m) bleeding scan localized brisk bleeding to the distal ileum.
- Surgical resection of the affected distal ileum was performed.
Findings:
- Histopathological examination of the resected ileum revealed cytomegalovirus (CMV) enteritis.
- CMV infection was identified as the cause of the significant GI bleeding.
- The patient's presentation underscores a rare but severe complication of CMV in pediatric HIV.
Implications:
- Cytomegalovirus (CMV) enteritis should be strongly considered in the differential diagnosis of GI bleeding in immunocompromised children, particularly those with HIV.
- Early recognition and diagnosis of CMV enteritis are crucial for timely management and improved outcomes in this vulnerable population.
- This case emphasizes the importance of a comprehensive diagnostic approach for GI complications in pediatric patients with severe immunosuppression.
Abstract:
A 4-month-old female child, recently diagnosed with parentally-acquired HIV complicated by moderate immunosuppression and pneumocystis carinii pneumonia (PCP), presented with hematochezia. A Tc-99m bleeding study was performed and demonstrated a site of brisk bleeding in the distal ileum. The patient was taken to the operating room and resection of the distal ileum revealed the presence of cytomegalovirus (CMV) enteritis. In immunocompromised children presenting with gastrointestinal (GI) hemorrhage, CMV enteritis should be considered.
