Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

Takahiro Yokose, Hideaki Obara, Masahiro Shinoda, Yutaka Nakano, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yohei Yamada, Kentaro Matsubara, Go Oshima, Shutaro Hori, Sho Ibuki, Hisanobu Higashi, Yuki Masuda, Masanori Hayashi, Takehiko Mori, Miho Kawaida, Takumi Fujimura, Ken Hoshino, Kaori KameyamaTatsuo Kuroda, Yuukou Kitagawa

Research output: Contribution to journalArticle

Abstract

BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

Original languageEnglish
Pages (from-to)1899-1906
Number of pages8
JournalWorld Journal of Gastroenterology
Volume25
Issue number15
DOIs
Publication statusPublished - 2019 Jan 1

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Gastroenteritis
Cytomegalovirus
Liver Transplantation
Colon
Transverse Colon
Gastrointestinal Endoscopy
Living Donors
Cytomegalovirus Infections
Organ Transplantation
Stomach Ulcer
Biopsy
Autoimmune Hepatitis
Ileostomy
Therapeutic Irrigation
Nuclear Family
Liver Cirrhosis
Immunosuppression
Ulcer
Drainage
Tomography

Keywords

  • Antigenemia negative
  • Case report
  • Colon perforation
  • Cytomegalovirus gastrointestinal disease
  • Liver transplantation

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{8a22b81d885745a78a40f3a59041e81e,
title = "Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature",
abstract = "BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.",
keywords = "Antigenemia negative, Case report, Colon perforation, Cytomegalovirus gastrointestinal disease, Liver transplantation",
author = "Takahiro Yokose and Hideaki Obara and Masahiro Shinoda and Yutaka Nakano and Minoru Kitago and Hiroshi Yagi and Yuta Abe and Yohei Yamada and Kentaro Matsubara and Go Oshima and Shutaro Hori and Sho Ibuki and Hisanobu Higashi and Yuki Masuda and Masanori Hayashi and Takehiko Mori and Miho Kawaida and Takumi Fujimura and Ken Hoshino and Kaori Kameyama and Tatsuo Kuroda and Yuukou Kitagawa",
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doi = "10.3748/wjg.v25.i15.1899",
language = "English",
volume = "25",
pages = "1899--1906",
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TY - JOUR

T1 - Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation

T2 - A case report and review of literature

AU - Yokose, Takahiro

AU - Obara, Hideaki

AU - Shinoda, Masahiro

AU - Nakano, Yutaka

AU - Kitago, Minoru

AU - Yagi, Hiroshi

AU - Abe, Yuta

AU - Yamada, Yohei

AU - Matsubara, Kentaro

AU - Oshima, Go

AU - Hori, Shutaro

AU - Ibuki, Sho

AU - Higashi, Hisanobu

AU - Masuda, Yuki

AU - Hayashi, Masanori

AU - Mori, Takehiko

AU - Kawaida, Miho

AU - Fujimura, Takumi

AU - Hoshino, Ken

AU - Kameyama, Kaori

AU - Kuroda, Tatsuo

AU - Kitagawa, Yuukou

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

AB - BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

KW - Antigenemia negative

KW - Case report

KW - Colon perforation

KW - Cytomegalovirus gastrointestinal disease

KW - Liver transplantation

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