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Clinical Manifestation of Cytomegalovirus-Associated Protein-Losing Enteropathy in Children

Claire Ferrua1, Anais Lemoine2, Alexis Mosca3

  • 1Paediatric Emergency Department, AP-HP, Robert Debré Hospital, Université Paris Cité, 48 Boulevard Sérurier, 75019 Paris, France.

Nutrients
|July 14, 2023
PubMed

Insights

Cytomegalovirus (CMV)-associated protein-losing enteropathy (PLE) in children often presents with edema and hypoalbuminemia. Non-invasive tests can confirm CMV-PLE, suggesting it

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Cytomegalovirus (CMV)-associated protein-losing enteropathy (PLE) in children is typically considered benign with spontaneous resolution.
  • However, it can manifest with generalized edema and hypoalbuminemia, often leading to unnecessary invasive diagnostic procedures.
  • The condition's characteristics and optimal diagnostic approaches require further elucidation, particularly in differentiating between immunocompetent and immunosuppressed pediatric populations.

Purpose of the Study:

  • To retrospectively describe clinical and biological features of CMV-associated PLE in children.
  • To analyze diagnostic methods, including non-invasive tests and endoscopy, and their impact on management.
  • To compare disease course and outcomes between immunocompetent and immunosuppressed pediatric patients.

Main Methods:

  • Retrospective analysis of pediatric patients diagnosed with CMV-associated PLE between 2009 and 2019 across two French hospitals.
  • Review of clinical data, laboratory results, CMV identification methods (non-invasive and invasive), endoscopic findings, and histological data.
  • Comparison of clinical presentation, disease severity, and management strategies between immunocompetent and immunosuppressed patient groups.

Main Results:

  • CMV-associated PLE was confirmed in 21 immunocompetent and 22 immunosuppressed children.
  • Digestive symptoms, particularly vomiting, were more prevalent in immunocompetent children (85.7%), who also exhibited more significant edema (61.9%) and severe hypoalbuminemia.
  • Non-invasive CMV detection methods were highly effective (88.9% and 95.5% in immunocompetent and immunosuppressed groups, respectively), with endoscopy often performed without altering treatment.

Conclusions:

  • CMV-associated PLE in children, especially those with generalized edema, warrants suspicion and should not be underestimated.
  • The condition can have a severe course, particularly in immunosuppressed children, and is not always benign as previously thought.
  • Non-invasive diagnostic tests are reliable for confirming CMV-associated PLE, potentially avoiding unnecessary invasive procedures.

Keywords:
cytomegalovirusendoscopygeneralised oedemaimmunosuppressedprotein-losing enteropathy

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