Korean J Intern Med.  2013 May;28(3):352-355. 10.3904/kjim.2013.28.3.352.

A case of hemophagocytic syndrome in a patient with fulminant ulcerative colitis superinfected by cytomegalovirus

• Mun JI
• Shin SJ
• Yu BH
• Koo JH
• Kim DH
• Lee KM
• Lee KJ

• KMID: 1776458
• DOI: http://doi.org/10.3904/kjim.2013.28.3.352

Abstract

Hemophagocytic syndrome (HPS) is an uncommon hematological disorder that manifests as fever, splenomegaly, and jaundice, with hemophagocytosis in the bone marrow and other tissues pathologically. Secondary HPS is associated with malignancy and infection, especially viral infection. The prevalence of cytomegalovirus (CMV) infection in ulcerative colitis (UC) patients is approximately 16%. Nevertheless, HPS in UC superinfected by CMV is very rare. A 52-year-old female visited the hospital complaining of abdominal pain and hematochezia for 6 days. She was diagnosed with UC 3 years earlier and had been treated with sulfasalazine, but had stopped her medication 4 months earlier. On admission, her spleen was enlarged. The peripheral blood count revealed pancytopenia and bone marrow aspiration smears showed hemophagocytosis. Viral studies revealed CMV infection. She was treated successfully with ganciclovir. We report this case with a review of the related literature.

Keyword

Colitis, ulcerative; Inflammatory bowel diseases; Cytomegalovirus infections; Lymphohistiocytosis, hemophagocytic

MeSH Terms

Antiviral Agents/therapeutic use
Colitis, Ulcerative/*complications/drug therapy
Cytomegalovirus Infections/*complications/drug therapy
Female
Ganciclovir/therapeutic use
Gastrointestinal Agents/therapeutic use
Gastrointestinal Hemorrhage/etiology
Humans
Lymphohistiocytosis, Hemophagocytic/drug therapy/*virology
Middle Aged
Sulfasalazine/therapeutic use
Superinfection/*complications
Antiviral Agents
Ganciclovir
Gastrointestinal Agents
Sulfasalazine